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Kim SY, Lee SJ. The characteristics of cognitive and daily living functions of neurocognitive disorders with delusions in elderly Alzheimer's disease. PeerJ 2024; 12:e18026. [PMID: 39285920 PMCID: PMC11404475 DOI: 10.7717/peerj.18026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2024] [Accepted: 08/12/2024] [Indexed: 09/19/2024] Open
Abstract
Background Delusions in neurocognitive disorder due to Alzheimer's disease (AD) worsen patients' cognitive functions and activities of daily living (ADL), increasing caregiver burden and the risk of mortality. AD patients with delusions tend to experience a more rapid decline in cognition and have demonstrated poorer performance on various cognitive function tests. Considering the prognosis of delusion in AD patients, it tends to be more favorable with appropriate treatment. However, there is a lack of neuropsychological research, specifically examining the impact of delusions in AD, characterized by progressive deterioration of cognitive function. This study investigates the impact of delusions on cognitive function and ADL under conditions controlling for disease severity. Methods We compared cognitive function and ADL in AD patients aged 65 years or older according to the presence of delusions. To assess longitudinal change, we analyzed data from patients monitored for an average of 15 to 16 months. We assessed cognitive function and ADL using the Seoul Neuropsychological Screening Battery-Second Edition (SNSB-II) and delusions using the Neuropsychiatric Inventory (NPI). We used IBM SPSS Statistics version 25.0 for all statistical analyses. The analysis was not adjusted for multiple comparisons. We investigated how delusions impact cognitive function and ADL, controlling for age, educational level, and disease severity. Results The delusions group exhibited poorer immediate recall of verbal memory than the non-delusions group. In the follow-up evaluation, patients who developed delusions had lower baseline cognitive function than those who did not, and their language fluency declined over time. In addition, we found the presence of delusions associated with worse functional impairment in ADL as the disease progressed. Conclusion While controlling for the severity of AD, we found no significant negative impacts of delusions on most cognitive functions. Nevertheless, it is noteworthy that the immediate recall of verbal memory and the Controlled Oral Word Association Test (COWAT)_animal sensitively detected the negative impact of delusions. Furthermore, since delusions are associated with worsening ADL, we understand that delusion treatment is important for improving the quality of life for patients and caregivers.
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Affiliation(s)
- Seo Yoo Kim
- Department of Psychology, Kyungpook National University, Daegu, Republic of South Korea
- Department of Neuropsychiatry, Good Samsun Hospital, Busan, Republic of South Korea
| | - Soo Jin Lee
- Department of Psychology, Kyungsung University, Busan, Republic of South Korea
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Jones MB, Gibson L, Gimenez-Zapiola M, Guerra A, Bhatti G, Broadway D, Tea J, Prasad A, Gates R, Hinton E, Jorge RE, Marsh L. Physical Violence and Aggression in Parkinson's Disease: A Systematic Review. J Acad Consult Liaison Psychiatry 2024; 65:366-378. [PMID: 38311061 PMCID: PMC11391672 DOI: 10.1016/j.jaclp.2024.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 01/10/2024] [Accepted: 01/28/2024] [Indexed: 02/06/2024]
Abstract
BACKGROUND Physical violence and aggression (PVA), defined as behaviors with the potential to cause bodily injury, are unfortunate risks in the management of all-cause neurodegenerative dementias. While dementia in Parkinson's disease (PD) may not be evident for many years after clinical onset, neuropsychiatric disturbances occur at all stages of the disease. At issue is whether PVA in PD is associated with clinical factors that can be targets for prevention and management in the absence of a prevailing dementia syndrome. OBJECTIVE This systematic review examined the extent to which PVA in PD without dementia is a clinically significant concern and whether it is associated with factors that could warrant proactive management. METHODS A systematic search of 9 electronic databases used MeSH headings and equivalent terms for PD, aggression, and violence. Eligible manuscripts were original articles that were published in peer-reviewed journals and reported on adults with PD in the awake state with PVA as possible outcomes. Extracted data included study design, PD ascertainment methods and characteristics, PVA assessment methods, subject demographics, psychiatric and medical comorbidities, and pertinent results. Inciting and confounding factors were extracted from case reports. Quality assessment tools were applied in accordance with the study design (e.g., observational, qualitative, or case report). RESULTS The search identified 10 manuscripts: 2 observational quantitative studies (total n with PD = 545), 1 qualitative study (n with PD = 20), and 7 case reports (n = 7). The observational studies suggested that PVA is less common than other neuropsychiatric disturbances, but heterogeneous methods and quality concerns prevented further conclusions. In the case reports, all patients were male, and most were early onset. In 6 of the reports, PVA occurred in the context of bilateral subthalamic nucleus deep brain stimulation. CONCLUSIONS PVA, while relatively rare in PD, can be a significant management issue that is associated with select premorbid characteristics and antiparkinsonian motor treatments. As PVA may be under-reported, further understanding of its frequency, causes, risk factors, and outcomes would benefit from its systematic assessment, ideally using self-report and informant-based questionnaires.
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Affiliation(s)
- Melissa B Jones
- Michael E. DeBakey VA Medical Center, Houston, TX; Department of Medicine, Baylor College of Medicine, Houston, TX.
| | - Lakeshia Gibson
- University of Mississippi Medical Center, Jackson, MS; Brigham and Women's Hospital, Boston, MA
| | - Malena Gimenez-Zapiola
- Michael E. DeBakey VA Medical Center, Houston, TX; Department of Medicine, Baylor College of Medicine, Houston, TX
| | - Ana Guerra
- Michael E. DeBakey VA Medical Center, Houston, TX; Department of Medicine, Baylor College of Medicine, Houston, TX
| | - Gursimrat Bhatti
- Michael E. DeBakey VA Medical Center, Houston, TX; Department of Medicine, Baylor College of Medicine, Houston, TX
| | - Dakota Broadway
- Michael E. DeBakey VA Medical Center, Houston, TX; Department of Medicine, Baylor College of Medicine, Houston, TX
| | - Juliann Tea
- Michael E. DeBakey VA Medical Center, Houston, TX; Department of Medicine, Baylor College of Medicine, Houston, TX
| | - Aksa Prasad
- Michael E. DeBakey VA Medical Center, Houston, TX; Department of Medicine, Baylor College of Medicine, Houston, TX; The University of Texas Rio Grande Valley, Edinburg, TX
| | - Rachel Gates
- Department of Medicine, Baylor College of Medicine, Houston, TX; UCHealth University of Colorado Hospital, Aurora, CO
| | | | - Ricardo E Jorge
- Michael E. DeBakey VA Medical Center, Houston, TX; Department of Medicine, Baylor College of Medicine, Houston, TX
| | - Laura Marsh
- Michael E. DeBakey VA Medical Center, Houston, TX; Department of Medicine, Baylor College of Medicine, Houston, TX
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Kim S, Na HK, Sun Y, Yoon YJ, Chung SJ, Sohn YH, Lyoo CH, Lee PH. Regional Burden of Enlarged Perivascular Spaces and Cognition and Neuropsychiatric Symptoms in Drug-Naive Patients With Parkinson Disease. Neurology 2024; 102:e209483. [PMID: 38833653 DOI: 10.1212/wnl.0000000000209483] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Although the potential role of enlarged perivascular spaces (EPVSs) in Parkinson disease (PD) is increasingly recognized, whether EPVSs located in different anatomical regions exert differential effects on clinical manifestation remains uncertain. We investigated the regional EPVS burden and its association with cognition and neuropsychiatric symptoms (NPSs) in newly diagnosed PD population. METHODS In this retrospective, cross-sectional study, EPVS in the temporal lobe (T-EPVS), centrum semiovale (CS-EPVS), and basal ganglia (BG-EPVS) were visually rated in drug-naive patients with PD who underwent magnetic resonance imaging, dopamine transporter (DAT) scans, neuropsychological assessments, and Neuropsychiatric Inventory Questionnaire at baseline. Cognitive performance, NPS burden, vascular risk factors, small vessel disease (SVD) imaging markers, and DAT availability were compared across groups dichotomized by their regional EPVS burden (cutoff for high-degree vs low-degree: >10 for T-EPVS/BG-EPVS and >20 for CS-EPVS). RESULTS A total of 480 patients with PD (123 without cognitive impairment, 291 with mild cognitive impairment, and 66 with dementia) were included. The proportion of high-degree T-EPVS (p for trend <0.001) and BG-EPVS (p for trend = 0.001) exhibited an increasing trend across the cognitive spectrum, corresponding to worsening cognition. Compared with the low-degree group, the high-degree BG-EPVS group showed higher SVD burden (moderate-to-severe white matter hyperintensity [14.8% vs 40.5%, p < 0.001], lacune [10.3% vs 30.7%, p < 0.001], and cerebral microbleeds [8.1% vs 22.2%, p < 0.001]), greater atrophy in cortical gray matter (40.73% ± 1.09% vs 39.96% ± 1.20% of intracranial volume, p < 0.001), and lower cognitive performance (in language [-0.22 ± 1.18 vs -0.53 ± 1.29, p = 0.013], and visual memory domains [-0.24 ± 0.97 vs -0.61 ± 0.96, p = 0.009]). The high-degree T-EPVS group presented with greater NPS burden in decreased motivation (0.61 ± 1.78 vs 1.35 ± 2.36, p = 0.007), affective dysregulation (0.88 ± 2.13 vs 2.36 ± 3.53, p < 0.001), and impulse dyscontrol (0.43 ± 1.67 vs 1.74 ± 4.29, p < 0.001), compared with the low-degree T-EPVS group. Meanwhile, the burden of CS-EPVS did not reveal any differences in cognition or NPS. DISCUSSION BG-EPVS and T-EPVS seem to exert differential effects on cognition and NPS in patients with PD. Investigating the EPVS profile in distinct anatomical regions may be useful in disentangling the heterogeneity within PD.
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Affiliation(s)
- Seokhyun Kim
- From the Department of Neurology (S.K., H.K.N., Y.S., Y.J.Y., Y.H.S., P.H.L.), Yonsei University College of Medicine, Seoul; Department of Neurology (S.J.C.), Yongin Severance Hospital, Yonsei University Health System; and Department of Neurology (C.H.L.), Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Han Kyu Na
- From the Department of Neurology (S.K., H.K.N., Y.S., Y.J.Y., Y.H.S., P.H.L.), Yonsei University College of Medicine, Seoul; Department of Neurology (S.J.C.), Yongin Severance Hospital, Yonsei University Health System; and Department of Neurology (C.H.L.), Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Yeeun Sun
- From the Department of Neurology (S.K., H.K.N., Y.S., Y.J.Y., Y.H.S., P.H.L.), Yonsei University College of Medicine, Seoul; Department of Neurology (S.J.C.), Yongin Severance Hospital, Yonsei University Health System; and Department of Neurology (C.H.L.), Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Yeo Jun Yoon
- From the Department of Neurology (S.K., H.K.N., Y.S., Y.J.Y., Y.H.S., P.H.L.), Yonsei University College of Medicine, Seoul; Department of Neurology (S.J.C.), Yongin Severance Hospital, Yonsei University Health System; and Department of Neurology (C.H.L.), Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Seok Jong Chung
- From the Department of Neurology (S.K., H.K.N., Y.S., Y.J.Y., Y.H.S., P.H.L.), Yonsei University College of Medicine, Seoul; Department of Neurology (S.J.C.), Yongin Severance Hospital, Yonsei University Health System; and Department of Neurology (C.H.L.), Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Young H Sohn
- From the Department of Neurology (S.K., H.K.N., Y.S., Y.J.Y., Y.H.S., P.H.L.), Yonsei University College of Medicine, Seoul; Department of Neurology (S.J.C.), Yongin Severance Hospital, Yonsei University Health System; and Department of Neurology (C.H.L.), Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Chul Hyoung Lyoo
- From the Department of Neurology (S.K., H.K.N., Y.S., Y.J.Y., Y.H.S., P.H.L.), Yonsei University College of Medicine, Seoul; Department of Neurology (S.J.C.), Yongin Severance Hospital, Yonsei University Health System; and Department of Neurology (C.H.L.), Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Phil Hyu Lee
- From the Department of Neurology (S.K., H.K.N., Y.S., Y.J.Y., Y.H.S., P.H.L.), Yonsei University College of Medicine, Seoul; Department of Neurology (S.J.C.), Yongin Severance Hospital, Yonsei University Health System; and Department of Neurology (C.H.L.), Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
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Kwak S, Kim H, Kim KY, Oh DY, Lee D, Nam G, Lee JY. Neuroanatomical and neurocognitive correlates of delusion in Alzheimer's disease and mild cognitive impairment. BMC Neurol 2024; 24:89. [PMID: 38448803 PMCID: PMC10916051 DOI: 10.1186/s12883-024-03568-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 02/12/2024] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND Neuropsychiatric symptoms and delusions are highly prevalent among people with dementia. However, multiple roots of neurobiological bases and shared neural basis of delusion and cognitive function remain to be characterized. By utilizing a fine-grained multivariable approach, we investigated distinct neuroanatomical correlates of delusion symptoms across a large population of dementing illnesses. METHODS In this study, 750 older adults with mild cognitive impairment and Alzheimer's disease completed brain structural imaging and neuropsychological assessment. We utilized principal component analysis followed by varimax rotation to identify the distinct multivariate correlates of cortical thinning patterns. Five of the cognitive domains were assessed whether the general cognitive abilities mediate the association between cortical thickness and delusion. RESULTS The result showed that distributed thickness patterns of temporal and ventral insular cortex (component 2), inferior and lateral prefrontal cortex (component 1), and somatosensory-visual cortex (component 5) showed negative correlations with delusions. Subsequent mediation analysis showed that component 1 and 2, which comprises inferior frontal, anterior insula, and superior temporal regional thickness accounted for delusion largely through lower cognitive functions. Specifically, executive control function assessed with the Trail Making Test mediated the relationship between two cortical thickness patterns and delusions. DISCUSSION Our findings suggest that multiple distinct subsets of brain regions underlie the delusions among older adults with cognitive impairment. Moreover, a neural loss may affect the occurrence of delusion in dementia largely due to impaired general cognitive abilities.
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Affiliation(s)
- Seyul Kwak
- Department of Psychology, Pusan National University, Busan, Republic of Korea
| | - Hairin Kim
- Department of Psychiatry, Seoul National University College of Medicine & SMG-SNU Boramae Medical Center, Seoul, 07061, Republic of Korea
| | - Keun You Kim
- Department of Psychiatry, Seoul National University College of Medicine & SMG-SNU Boramae Medical Center, Seoul, 07061, Republic of Korea
| | - Da Young Oh
- Department of Psychiatry, Seoul National University College of Medicine & SMG-SNU Boramae Medical Center, Seoul, 07061, Republic of Korea
| | - Dasom Lee
- Department of Psychiatry, Seoul National University College of Medicine & SMG-SNU Boramae Medical Center, Seoul, 07061, Republic of Korea
| | - Gieun Nam
- Department of Psychiatry, Seoul National University College of Medicine & SMG-SNU Boramae Medical Center, Seoul, 07061, Republic of Korea
| | - Jun-Young Lee
- Department of Psychiatry, Seoul National University College of Medicine & SMG-SNU Boramae Medical Center, Seoul, 07061, Republic of Korea.
- Department of Medical Device Development, Seoul National University College of Medicine, Seoul, Republic of Korea.
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Cho E, Lee H, Shin J, Kim S, Heo SJ, Park H, Seok JW. Salivary Cortisol and Melatonin, Sleep, and Behavioral Patterns in Older Adults Living With Dementia. Nurs Res 2024; 73:E11-E20. [PMID: 38112608 DOI: 10.1097/nnr.0000000000000709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Abstract
BACKGROUND Over half of the older adults living with dementia have behavioral and psychological symptoms of dementia (BPSD), including sleep disturbance; however, little is known about physiological markers. Salivary cortisol and melatonin have been identified as potential biomarkers of BPSD, with evidence suggesting a relationship between these biomarkers and various behavioral factors, as well as sleep and activity patterns. OBJECTIVES The aim of this study was to investigate the time-dependent changes in salivary cortisol and melatonin levels in older adults with dementia, their relationship with the sleep-wake cycle, and their correlation with BPSD symptoms and behavioral factors. METHODS This observational study conducted in Seoul and Gyeonggi-do, South Korea, used data from 172 older adults with dementia, measuring sleep and activity patterns for 2 weeks using a wearable device, in addition to administering questionnaires for neuropsychiatric and psychological symptoms-the Neuropsychiatric Inventory, Cohen-Mansfield Agitation Inventory, and Cornell Scale for Depression in Dementia. Salivary cortisol and melatonin levels were measured at four time points and divided into four groups based on a dual-trajectory model. Differences among the groups were analyzed using one-way analysis of variance. RESULTS The participants showed normal but heterogeneous patterns of salivary cortisol and melatonin levels. Dual-trajectory pattern analysis showed that higher levels of melatonin during the daytime were correlated with poor nighttime sleep efficiency and decreased disinhibited behaviors, and higher levels of cortisol at all four time points were associated with decreased physical activity. DISCUSSION Measuring and analyzing periodic changes in cortisol and melatonin levels can predict various behavioral symptoms (e.g., sleep disturbances, activity counts, and disinhibition) in older adults with dementia. A study with an experimental design is needed to discover the direct physiological interactions between cortisol, melatonin, and these symptoms.
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Cho E, Yang M, Jang J, Cho J, Kang B, Jang Y, Kim MJ. A mobile app to predict and manage behavioral and psychological symptoms of dementia: Development, usability, and users' acceptability. Digit Health 2024; 10:20552076241249277. [PMID: 38698833 PMCID: PMC11064751 DOI: 10.1177/20552076241249277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 04/08/2024] [Indexed: 05/05/2024] Open
Abstract
Objective: Non-pharmacological interventions are considered the first-line treatment for behavioral and psychological symptoms of dementia (BPSD); however, traditional approaches have shown only small effect sizes. Mobile technology offers an opportunity to improve BPSD assessment and management in people living with dementia (PLWD). We aimed (1) to develop a mobile application (app) featuring a real-time BPSD diary, machine-learning-based BPSD prediction, and individualized non-pharmacological care programs, including therapeutic use of music and reminiscent content, and (2) to test its usability, acceptability, and preliminary efficacy among PLWD and caregivers. Methods: An Android-based app was developed through the following three phases: (1) needs assessment, (2) software development and initial testing with experts, and (3) beta-testing with end users who were dyads of PLWD and caregivers. The preliminary efficacy, usability, and acceptability of the app were assessed using validated BPSD questionnaires and face-to-face interviews with the dyads. Logs of the dyads' program participation (i.e., types, time, and duration), BPSD diaries, and engagement levels of PLWD were also collected through the app. Results: Five dyads created BPSD diaries (range: 22-48) over 3 weeks. Overall, the BPSD symptoms decreased after the beta-testing period. Each dyad participated in the care programs for 106-204 min, during which music alone was most frequently used. Engagement levels ranged from 3.38 to 4.94 (out of 5). Conclusions: The app was deemed usable, acceptable, and feasible for PLWD and caregivers. The upgraded app will be further tested and can be easily implemented at home or in the community.
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Affiliation(s)
- Eunhee Cho
- Mo-Im Kim Nursing Research Institute, College of Nursing, Yonsei University, Seoul, Korea
| | - Minhee Yang
- College of Nursing and Brain Korea 21 FOUR Project, Yonsei University, Seoul, Korea
| | - Jiyoon Jang
- College of Nursing and Brain Korea 21 FOUR Project, Yonsei University, Seoul, Korea
| | - Jungwon Cho
- College of Nursing, Yonsei University, Seoul, Korea
| | - Bada Kang
- Mo-Im Kim Nursing Research Institute, College of Nursing, Yonsei University, Seoul, Korea
- Institute for Innovation in Digital Healthcare, Yonsei University, Seoul, Korea
| | | | - Min Jung Kim
- Mo-Im Kim Nursing Research Institute, College of Nursing, Yonsei University, Seoul, Korea
- College of Nursing, Gachon University, Seoul, Korea
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Kim MG, Hyun MS, Park SG, Cho E, Kim J, Choi HK, Son KL, Lim CY, Kim KK, Koo BS. Efficacy and Safety of Woohwangchungsimwon Combined with Donepezil in Behavioral and Psychological Symptoms of Dementia in Patients with Probable Alzheimer's Disease: Study Protocol for a Randomized Controlled Trial. Healthcare (Basel) 2023; 11:2036. [PMID: 37510478 PMCID: PMC10378906 DOI: 10.3390/healthcare11142036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 07/08/2023] [Accepted: 07/14/2023] [Indexed: 07/30/2023] Open
Abstract
Behavioral and psychological symptoms of dementia are a major factor in the burden of care and medical expenses. Conventional pharmacological treatments do not exert a distinct effect on the benefits versus the risks. The herbal medicine woohwangchungsimwon is frequently prescribed for neuropsychiatric disorders. An effect of woohwangchungsimwon on behavioral and psychological symptoms of dementia has been previously reported; however, no clinical studies have been conducted. We aim to evaluate the efficacy and safety of woohwangchungsimwon combined with donepezil for alleviating these symptoms in probable Alzheimer's disease. In this randomized, assessor-blinded, parallel-group clinical trial, 74 participants with probable Alzheimer's disease will be divided via block randomization into a woohwangchungsimwon + donepezil combination group (n = 37) or a donepezil single group (n = 37). Participants will include patients under donepezil treatment for at least a month. We will perform the study for 24 weeks. The Neuro-Psychiatric Inventory subscale scores will be the primary outcome. Secondary outcomes will include cognitive function, dementia severity, physical function, quality of life, depression, anxiety, and insomnia. For safety evaluation, we will assess adverse reactions, measure vital signs, and conduct laboratory tests. This is the first trial aiming to confirm the efficacy and safety of woohwangchungsimwon combined with donepezil for alleviating behavioral and psychological symptoms of dementia. Its findings could provide a basis for their co-administration to control these symptoms in probable Alzheimer's disease.
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Affiliation(s)
- Man Gi Kim
- Department of Oriental Neuropsychiatry, Dongguk University Ilsan Oriental Hospital, Goyang 10326, Republic of Korea
- Department of Oriental Neuropsychiatry, Graduate School of Dongguk University, Seoul 04620, Republic of Korea
| | - Mi-Suk Hyun
- Department of Nursing, Kyungdong University, Wonju 26495, Republic of Korea
| | - Sang Gu Park
- Department of Neurology, Dongguk University Ilsan Hospital, Goyang 10326, Republic of Korea
| | - Eun Cho
- College of Pharmacy, Sookmyung Women's University, Seoul 04310, Republic of Korea
| | - Jinsik Kim
- Department of Medical Biotechnology, College of Life Science and Biotechnology, Dongguk University, Seoul 04620, Republic of Korea
| | - Hyung-Kyoon Choi
- College of Pharmacy, Chung-Ang University, Seoul 06974, Republic of Korea
| | - Kyung-Lak Son
- Department of Psychiatry, Dongguk University Ilsan Hospital, Goyang 10326, Republic of Korea
| | - Chi-Yeon Lim
- Department of Biostatistics, College of Medicine, Dongguk University, Goyang 10326, Republic of Korea
| | - Kwang Ki Kim
- Department of Neurology, Dongguk University Ilsan Hospital, Goyang 10326, Republic of Korea
| | - Byung Soo Koo
- Department of Oriental Neuropsychiatry, Dongguk University Ilsan Oriental Hospital, Goyang 10326, Republic of Korea
- Department of Oriental Neuropsychiatry, Graduate School of Dongguk University, Seoul 04620, Republic of Korea
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Tayeb HO, Butt NS, Khallaf R, Yahghmour B, Basheikh MA, Alamri SH, Baduwailan AO, Alzaben F, Abdulghaffar HK, Koenig HG. Alzheimer's Behavioral and Psychiatric Burden in Saudi Arabia: Validation of the Saudi Version of the Neuropsychiatric Inventory. Alzheimer Dis Assoc Disord 2023; 37:222-228. [PMID: 37561963 DOI: 10.1097/wad.0000000000000563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 05/03/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND The burden of behavioral and psychiatric symptoms in dementia (BPSD) has not been characterized in Saudi patients with Alzheimer disease (AD). Moreover, the Saudi version of the Neuropsychiatric Inventory (SNPI) has not been validated. OBJECTIVES The purpose of this study was to validate the SNPI and describe frequency and determinants of BPSD in Saudi AD patients. METHODS The SNPI and BEHAVE-AD instruments were administered to community-dwelling Saudi AD patients and their caregivers. RESULTS The sample size was 192. The first 59 constituted the validation cohort. Cronbach alpha of the SNPI and BEHAVE-AD were 0.91 and 0.79, respectively. There were significant correlations between: (1) the total SNPI and BEHAVE-AD scores ( r =0.84, P <0.001); (2) analogous SNPI and BEHAVE-AD symptom subscores ( P <0.05); (3) SNPI and BEHAVE-AD caregiver distress ( F =22.6, P <0.001). Inter-rater reliability of the SNPI was excellent (kappa=0.74). Ninety percent of patients experienced 4 SNPI symptoms or more. Patients with stroke and prior psychiatric history were most likely to experience BPSDs. The most common symptom was apathy (82%). Caregiver distress was determined by the total NPI score and impulsiveness subscale score. CONCLUSIONS The SNPI is valid and reliable for assessing BPSD in Saudi AD patients. Longitudinal studies of BPSDs in Saudi specialized dementia clinics are needed.
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Affiliation(s)
- Haythum O Tayeb
- The Neuroscience Research Unit and the Mind and Brain Studies Initiative, Division of Neurology, Department of Internal Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah
| | - Nadeem S Butt
- The Faculty of Medicine in Rabigh, King Abdulaziz University, Rabigh
| | - Roaa Khallaf
- Department of Neurology, Neuroscience Center, King Fahad Specialist Hospital Dammam
| | - Bassam Yahghmour
- The Neuroscience Research Unit and the Mind and Brain Studies Initiative, Division of Neurology, Department of Internal Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah
| | | | - Sultan H Alamri
- Family Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Abrar O Baduwailan
- The Neuroscience Research Unit and the Mind and Brain Studies Initiative, Division of Neurology, Department of Internal Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah
| | | | - Haifa K Abdulghaffar
- The Neuroscience Research Unit and the Mind and Brain Studies Initiative, Division of Neurology, Department of Internal Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah
| | - Harold G Koenig
- Division of Psychiatry Internal Medicine
- Departments of Psychiatry and Behavioral Sciences
- Medicine, Duke University Medical Center, Durham, North Carolina
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Kwak S, Kim H, Oh DJ, Jeon YJ, Oh DY, Park SM, Lee JY. Lower cognitive function attenuates the convergence between self-ratings and observer ratings of depressive symptoms in late-life cognitive impairment. Brain Behav 2023; 13:e2898. [PMID: 36756689 PMCID: PMC10013952 DOI: 10.1002/brb3.2898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 01/09/2023] [Accepted: 01/12/2023] [Indexed: 02/10/2023] Open
Abstract
OBJECTIVES Assessment of depressive symptoms in older adults is challenging especially in the presence of risks in cognitive impairment. We aimed to examine whether the convergence between two measures of depressive symptoms (self-report and observer ratings) is affected by varying levels of cognitive function in older adults. METHODS Self-reported scale of depression, informant-based rating of affective symptoms, and global cognitive function were assessed in 2533 older adults with no impairment, mild cognitive impairment, and Alzheimer's disease. The strength of rank-order correlation between the Geriatric Depression Scale (GDS) and behavioral ratings of the Neuropsychiatric Inventory (NPI) was examined as the metric of convergent validity. RESULTS The results showed that the strength of convergence between the two measurements gradually decreased as a function of lowered cognitive function. Overall tendency showed that diagnoses of cognitive impairment and lower levels of cognitive function were associated with lower correspondence between the two depression measurements. The loss of convergent validity is especially evident in the behavioral symptom of apathy. CONCLUSIONS Utilizing self-report scales of depression in older adults requires a cautious approach even with minimal or mild levels of cognitive impairment.
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Affiliation(s)
- Seyul Kwak
- Department of Psychology, Pusan National University, Busan, Republic of Korea
| | - Hairin Kim
- Department of Psychiatry, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Dae Jong Oh
- Department of Psychiatry, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Yeong-Ju Jeon
- Department of Psychiatry, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Da Young Oh
- Department of Psychiatry, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Su Mi Park
- Department of Counseling Psychology, Hannam University, Daejeon, Republic of Korea
| | - Jun-Young Lee
- Department of Psychiatry, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Republic of Korea
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10
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Kim HR, Shin HY, Yim TB, Jahng GH, Jin C, Kwon S, Cho SY, Park SU, Jung WS, Moon SK, Ko CN, Park JM. Efficacy of Kami Guibi-tang as an Add-On Therapy to Acetylcholinesterase Inhibitor for Cognitive Function in Mild Alzheimer's Disease: A Pilot Study. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2023; 2023:4846770. [PMID: 36756039 PMCID: PMC9902163 DOI: 10.1155/2023/4846770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 04/05/2022] [Accepted: 12/23/2022] [Indexed: 02/01/2023]
Abstract
Background Kami Guibi-tang (KGT), a traditional Korean herbal medicine is mainly used to treat insomnia and nervousness. Acetylcholinesterase inhibitors (AChEIs) are the main treatments for mild Alzheimer's disease (AD), a degenerative brain disease. However, currently no drug can fundamentally treat AD or reverse the advanced cognitive decline. This clinical study explored the efficacy and safety of adding KGT to AChEI for cognitive function in mild AD. Methods This was a pilot study for a larger randomized, double-blind, placebo-controlled trial. Participants between 55-90 years diagnosed with mild AD were recruited from Kyung Hee University Hospital at Gangdong, Seoul, Korea. They were randomized to receive either KGT or placebo for 24 weeks, in addition to their regular AChEI. The primary outcome was treatment efficacy, as assessed by the relative amount of change over the study period in total scores on the Dementia version of the Seoul Neuropsychological Screening Battery (SNSB-D). Changes in SNSB subscores were assessed as secondary outcomes. Safety parameters, including adverse events and abnormalities in blood tests, electrocardiograms, and brain magnetic resonance imaging were also monitored. Results Between March 2018 and November 2020, seven participants each in the KGT group and the placebo group completed the 24-week trial. There were no significant changes in SNSB-D total or subindex scores for either group (p = 0.69 and 0.63, respectively), and no significant differences were observed between them (p=0.71). No adverse events related to KGT were reported. We also compared and analyzed the results of a previous pilot study conducted on amnestic mild cognitive impairment (aMCI) using protocol of this study. The aMCI group showed a significant improvement in the total SNSB-D score, especially in the memory domain, compared to the mild AD group (p = 0.04 and 0.02, respectively). The Korean Mini-Mental State Exam and Korean Instrumental Activities of Daily Living scores also significantly improved in the aMCI group (p = 0.01 and 0.02, respectively). Conclusions Compared to placebo, adding KGT to AChEI did not significantly improve cognitive function in SNSB in patients with mild AD. We suggest that KGT would have a positive effect on patients with early stages of cognitive impairment such as aMCI. The findings could assist design larger, longer-term clinical trials of KGT use in elderly patients with mild AD. This study was registered in the Korean Clinical Trial Registry on December 26, 2017, with the CRIS approval number KCT0002904.
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Affiliation(s)
- Ha-Ri Kim
- Department of Clinical Korean Medicine, Graduate School, Kyung Hee University, Seoul, Republic of Korea
| | - Hee-Yeon Shin
- Department of Clinical Korean Medicine, Graduate School, Kyung Hee University, Seoul, Republic of Korea
| | - Tae-Bin Yim
- Department of Clinical Korean Medicine, Graduate School, Kyung Hee University, Seoul, Republic of Korea
| | - Geon-Ho Jahng
- Department of Radiology, Kyung Hee University College of Medicine, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea
| | - Chul Jin
- Department of Cardiology and Neurology, College of Korean Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Seungwon Kwon
- Department of Cardiology and Neurology, College of Korean Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Seung-Yeon Cho
- Department of Cardiology and Neurology, College of Korean Medicine, Kyung Hee University, Seoul, Republic of Korea
- Stroke and Neurological Disorders Center, Kyung Hee University College of Korean Medicine, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea
| | - Seong-Uk Park
- Department of Cardiology and Neurology, College of Korean Medicine, Kyung Hee University, Seoul, Republic of Korea
- Stroke and Neurological Disorders Center, Kyung Hee University College of Korean Medicine, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea
| | - Woo-Sang Jung
- Department of Cardiology and Neurology, College of Korean Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Sang-Kwan Moon
- Department of Cardiology and Neurology, College of Korean Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Chang-Nam Ko
- Department of Cardiology and Neurology, College of Korean Medicine, Kyung Hee University, Seoul, Republic of Korea
- Stroke and Neurological Disorders Center, Kyung Hee University College of Korean Medicine, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea
| | - Jung-Mi Park
- Department of Cardiology and Neurology, College of Korean Medicine, Kyung Hee University, Seoul, Republic of Korea
- Stroke and Neurological Disorders Center, Kyung Hee University College of Korean Medicine, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea
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11
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Park K, Moon S. Informative and semantic language features of people with dementia displayed during reminiscence therapy. Psychogeriatrics 2022; 22:843-850. [PMID: 36075583 DOI: 10.1111/psyg.12891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 07/25/2022] [Accepted: 08/17/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Communication is essential for people with dementia (PWD) to independently perform activities of daily living. While cognitive training could improve communication abilities in PWD, there is limited evidence of the effect of reminiscence therapy (RT) on communication. Therefore, this study examines this effect, focusing on language features. METHOD This study used data from randomised controlled trials applying RT to women with dementia registered in a day-care center. RT using digital material or storytelling was conducted with PWD for 4 weeks. Outcome measures included general characteristics and communicative ability, such as the number of correct information units (CIUs, a measure of informativeness in discourse), the Holden Communication Scale (HCS) score, and verbal engagement. Repeated-measures multivariate analysis of variance and the paired t-test were performed to confirm the effect of RT on communicative ability. RESULTS There was a significant change over time in the ratio of CIUs (F = 4.35, P = 0.016). In the first 2 weeks of the intervention, there were significant differences in the ratio of CIUs (t = -3.00, P = 0.005), total HCS score (t = 2.28, P = 0.028), and conversation score (HCS subdomain) (t = 2.44, P = 0.019) between two measurement time points (T0, T1), while the number of syllables did not significantly change (t = -1.60, P = 0.117). CONCLUSIONS Informative/semantic linguistic ability was significantly increased in PWD, while the amount of discourse did not change after RT. This result may be helpful to improve effective communication with PWD and train healthcare staff working with PWD.
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Affiliation(s)
- Kyongok Park
- Department of Nursing, Gangneung-Wonju National University, Wonju-si, Gangwon-do, South Korea
| | - SeolHwa Moon
- Research Institute of Nursing Science, Hanyang University, Seoul, South Korea
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12
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Kwak S, Kim H, Oh DJ, Jeon YJ, Oh DY, Park SM, Lee JY. Clinical and biological subtypes of late-life depression. J Affect Disord 2022; 312:46-53. [PMID: 35691418 DOI: 10.1016/j.jad.2022.06.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 05/26/2022] [Accepted: 06/06/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Late-life depression (LDD) results from multiple psychosocial and neurobiological changes occurring in later life. The current study investigated how patterns of clinical symptoms and brain structural features are classified into LDD subtypes. METHOD Self-report scale of depression, behavioral rating of affective symptoms, and brain structural imaging of white matter change and cortical thickness were assessed in 541 older adults with no cognitive impairment or mild cognitive impairment. Latent profile analysis was used to identify distinct subtypes of depression. RESULTS The latent profile analysis identified four classes with mild to severe depressive symptoms and two classes with minimal symptoms. While the classes primarily differed in the overall severity, the combinatory patterns of clinical symptoms and neuropathological signature distinguished the classes with similar severity. The classes were distinguished in terms of whether or not neurodegenerative risk accompanied the corresponding depressive symptoms. The presence of the negative self-scheme and cortical thinning pattern notably characterized the subtypes of LDD. LIMITATIONS The underlying etiologies of the biological subtypes are still speculative, and the current study lacks clinical history that differentiates late- and early-onset depression. CONCLUSIONS Our finding provides insight in identifying heterogeneities of depressive disorder in later life and suggests that self-report and behavioral symptom profile in combination with white matter lesion and cortical thickness effectively characterizes distinct subtypes of LDD.
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Affiliation(s)
- Seyul Kwak
- Department of Psychology, Pusan National University, Republic of Korea
| | - Hairin Kim
- Department of Psychiatry, Seoul National University College of Medicine & SMG-SNU Boramae Medical Center, Republic of Korea
| | - Dae Jong Oh
- Department of Psychiatry, Seoul National University College of Medicine & SMG-SNU Boramae Medical Center, Republic of Korea
| | - Yeong-Ju Jeon
- Department of Psychiatry, Seoul National University College of Medicine & SMG-SNU Boramae Medical Center, Republic of Korea
| | - Da Young Oh
- Department of Psychiatry, Seoul National University College of Medicine & SMG-SNU Boramae Medical Center, Republic of Korea
| | - Su Mi Park
- Department of Counseling Psychology, Hannam University, Republic of Korea
| | - Jun-Young Lee
- Department of Psychiatry, Seoul National University College of Medicine & SMG-SNU Boramae Medical Center, Republic of Korea.
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13
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Multiple Cognitive and Behavioral Factors Link Association Between Brain Structure and Functional Impairment of Daily Instrumental Activities in Older Adults. J Int Neuropsychol Soc 2022; 28:673-686. [PMID: 34308821 DOI: 10.1017/s1355617721000916] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVE Functional impairment in daily activity is a cornerstone in distinguishing the clinical progression of dementia. Multiple indicators based on neuroimaging and neuropsychological instruments are used to assess the levels of impairment and disease severity; however, it remains unclear how multivariate patterns of predictors uniquely predict the functional ability and how the relative importance of various predictors differs. METHOD In this study, 881 older adults with subjective cognitive complaints, mild cognitive impairment (MCI), and dementia with Alzheimer's type completed brain structural magnetic resonance imaging (MRI), neuropsychological assessment, and a survey of instrumental activities of daily living (IADL). We utilized the partial least square (PLS) method to identify latent components that are predictive of IADL. RESULTS The result showed distinct brain components (gray matter density of cerebellar, medial temporal, subcortical, limbic, and default network regions) and cognitive-behavioral components (general cognitive abilities, processing speed, and executive function, episodic memory, and neuropsychiatric symptoms) were predictive of IADL. Subsequent path analysis showed that the effect of brain structural components on IADL was largely mediated by cognitive and behavioral components. When comparing hierarchical regression models, the brain structural measures minimally added the explanatory power of cognitive and behavioral measures on IADL. CONCLUSION Our finding suggests that cerebellar structure and orbitofrontal cortex, alongside with medial temporal lobe, play an important role in the maintenance of functional status in older adults with or without dementia. Moreover, the significance of brain structural volume affects real-life functional activities via disruptions in multiple cognitive and behavioral functions.
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14
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Jung G, Lee J. Behavioral and Psychological Symptoms and Associated Factors in Community-Dwelling Persons at the First Time of Dementia Diagnosis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19137765. [PMID: 35805421 PMCID: PMC9265813 DOI: 10.3390/ijerph19137765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 06/20/2022] [Accepted: 06/21/2022] [Indexed: 12/03/2022]
Abstract
Background: Community-dwelling residents at potential risk of dementia and their families have difficulty detecting symptoms of dementia during an outbreak of coronavirus disease-19 (COVID-19). We explored the characteristics of behavioral and psychological symptoms of dementia (BPSD) in community-dwelling persons at the first time of dementia diagnosis and identified their associated variables. Methods: A cross-sectional study using secondary data of dementia diagnosis tests was conducted. Data were reported by professional nurses and clinicians from 355 persons at the first time of dementia diagnosis in South Korea. BPSD and their associated variables were measured with the Neuropsychiatric Inventory, the Korean version of the Consortium to Establish a Registry for Alzheimer’s Disease (CERAD-K) assessment handbook and electronic medical records. Results: The most common symptoms were apathy/indifference (72.1%), followed by irritability/lability (42.8%) and depression/dysphoria (42.0%). Hierarchical regression analyses showed that the strongest factor associated with BPSD was dementia type (β = −0.18, p = 0.001) mostly severer in frontotemporal dementia, followed by activities of daily living dependency (β = 0.15, p = 0.033), and number of medications (β = 0.10, p = 0.048). Conclusion: Providing information based on the study findings to families who are caring for persons at potential risk of dementia, may be able to detect dementia symptoms early and manage appropriate care.
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Affiliation(s)
- Gijung Jung
- Graduate School, Kyung Hee University, Seoul 02447, Korea;
| | - Jia Lee
- College of Nursing Science, Kyung Hee University, Seoul 02447, Korea
- Correspondence:
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15
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Abstract
OBJECTIVES To investigate conditional dependence relationships of impulse dyscontrol symptoms in mild cognitive impairment (MCI) and subjective cognitive decline (SCD). DESIGN A prospective, observational study. PARTICIPANTS Two hundred and thirty-five patients with MCI (n = 159) or SCD (n = 76) from the Prospective Study for Persons with Memory Symptoms dataset. MEASUREMENTS Items of the Mild Behavioral Impairment Checklist impulse dyscontrol subscale. RESULTS Stubbornness/rigidity, agitation/aggressiveness, and argumentativeness were frequent and the most central symptoms in the network. Impulsivity, the fourth most central symptom in the network, served as the bridge between these common symptoms and less central and rare symptoms. CONCLUSIONS Impulse dyscontrol in at-risk states for dementia is characterized by closely connected symptoms of irritability, agitation, and rigidity. Compulsions and difficulties in regulating rewarding behaviors are relatively isolated symptoms.
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16
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Lim JO, Gu MO. [Development and Effects of a Person-Centered Fall Prevention Program for Older Adults with Dementia in Long-Term Care Hospitals: For Older Adults with Dementia and Caregivers in Long-Term Care Hospitals]. J Korean Acad Nurs 2022; 52:341-358. [PMID: 35818881 DOI: 10.4040/jkan.21230] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 04/08/2022] [Accepted: 06/20/2022] [Indexed: 11/09/2022]
Abstract
PURPOSE This study examined the effects of a person-centered fall prevention program for older adults with dementia in long-term care hospitals. METHODS A nonequivalent control group pretest-posttest design was used. The study sample included 42 older adults with dementia (experimental group: 21, control group: 21) and 42 caregivers (experimental group: 21, control group: 21). The program comprised 48 sessions held over 12 weeks and included exercise intervention with resistance and balance, dance walking (45~60 min, three times/week), cognitive and emotional intervention (35~50 min, once per week), and person-centered fall prevention education (10 min, once per week). The program for caregivers consisted of six educational sessions (i.e., fall prevention competency enhancement and person-centered care strategy education, 80 min, once per week) for six weeks. Data were collected before participation and 12 weeks after program completion from February 18 to May 12, 2019. Data analysis was conducted using the chi-square test, t-test, and Mann-Whitney U test with SPSS/WIN 21.0. RESULTS The experimental group of older adults with dementia showed significant improvement in physical and cognitive functions, and a decrease in depression, and behavioral and psychological symptoms, when compared with the control group. caregivers in the experimental group exhibited significant improvement in fall-related knowledge and person-centered care of older adults with dementia compared to the control group. CONCLUSION The study findings indicate that this program was effective as a nursing intervention for fall prevention among older adults with dementia in long-term care hospitals.
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Affiliation(s)
- Jeong Ok Lim
- Department of Nursing, Kyongbuk Science College, Chilgok, Korea
| | - Mee Ock Gu
- College of Nursing, Gyeongsang National University, Jinju, Korea.
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17
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Saari T, Koivisto A, Hintsa T, Hänninen T, Hallikainen I. Psychometric Properties of the Neuropsychiatric Inventory: A Review. J Alzheimers Dis 2022; 86:1485-1499. [PMID: 32925068 PMCID: PMC9108559 DOI: 10.3233/jad-200739] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/28/2020] [Indexed: 11/15/2022]
Abstract
Neuropsychiatric symptoms cause a significant burden to individuals with neurocognitive disorders and their families. Insights into the clinical associations, neurobiology, and treatment of these symptoms depend on informant questionnaires, such as the commonly used Neuropsychiatric Inventory (NPI). As with any scale, the utility of the NPI relies on its psychometric properties, but the NPI faces unique challenges related to its skip-question and scoring formats. In this narrative review, we examined the psychometric properties of the NPI in a framework including properties pertinent to construct validation, and health-related outcome measurement in general. We found that aspects such as test-retest and inter-rater reliability are major strengths of the NPI in addition to its flexible and relatively quick administration. These properties are desired in clinical trials. However, the reported properties appear to cover only some of the generally examined psychometric properties, representing perhaps necessary but insufficient reliability and validity evidence for the NPI. The psychometric data seem to have significant gaps, in part because small sample sizes in the relevant studies have precluded more comprehensive analyses. Regarding construct validity, only one study has examined structural validity with the NPI subquestions. Measurement error was not assessed in the reviewed studies. For future validation, we recommend using data from all subquestions, collecting larger samples, paying specific attention to construct validity and formulating hypotheses a priori. Because the NPI is an outcome measure of interest in clinical trials, examining measurement error could be of practical importance.
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Affiliation(s)
- Toni Saari
- University of Eastern Finland, Neurology, Kuopio, Finland
- University of Eastern Finland, School of Educational Sciences and Psychology, Joensuu, Finland
| | - Anne Koivisto
- University of Eastern Finland, Neurology, Kuopio, Finland
- Kuopio University Hospital, Neurology, Kuopio, Finland
- University of Helsinki, Department of Neurosciences, Helsinki, Finland
- Helsinki University Hospital, Geriatrics, Department of Internal Medicine and Rehabilitation, Helsinki, Finland
| | - Taina Hintsa
- University of Eastern Finland, School of Educational Sciences and Psychology, Joensuu, Finland
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18
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Burgon C, Goldberg SE, van der Wardt V, Brewin C, Harwood RH. Apathy Measures in Older Adults and People with Dementia: A Systematic Review of Measurement Properties Using the COSMIN Methodology. Dement Geriatr Cogn Disord 2021; 50:111-123. [PMID: 33975314 DOI: 10.1159/000515678] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 03/01/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Apathy is highly prevalent in dementia and is also seen in mild cognitive impairment and the general population. Apathy contributes to failure to undertake daily activities and can lead to health problems or crises. It is therefore important to assess apathy. However, there is currently no gold standard measure of apathy. A comprehensive systematic review of the measurement properties of apathy scales is required. METHODS A systematic review was registered with PROSPERO (ID: CRD42018094390). MEDLINE, Embase, PsycINFO, and CINAHL were searched for studies that aimed to develop or assess the validity or reliability of an apathy scale in participants over 65 years, living in the community. A systematic review was conducted in line with the COnsensus-based Standards for the selection of health Measurement INstruments procedure for reviewing patient-reported outcome measures. The studies' risk of bias was assessed, and all relevant measurement properties were assessed for quality. Results were pooled and rated using a modified Grading of Recommendations Assessment, Development, and Evaluation procedure. RESULTS Fifty-seven publications regarding 18 measures and 39 variations met the eligibility criteria. The methodological quality of individual studies ranged from inadequate to very good and measurement properties ranged from insufficient to sufficient. Similarly, the overall evidence for measurement properties ranged from very low to high quality. The Apathy Evaluation Scale (AES) and Lille Apathy Rating Scale (LARS) had sufficient content validity, reliability, construct validity, and where applicable, structural validity and internal consistency. CONCLUSION Numerous scales are available to assess apathy, with varying psychometric properties. The AES and LARS are recommended for measuring apathy in older adults and people living with dementia. The apathy dimension of the commonly used Neuropsychiatric Inventory should be limited to screening for apathy.
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Affiliation(s)
- Clare Burgon
- School of Health Sciences, University of Nottingham, Nottingham, United Kingdom.,Division of Rehabilitation, Ageing and Wellbeing, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | | | - Veronika van der Wardt
- Division of Rehabilitation, Ageing and Wellbeing, School of Medicine, University of Nottingham, Nottingham, United Kingdom.,Department of General Medicine, Preventative and Rehabilitative Medicine, Philipps-Universität Marburg, Marburg, Germany
| | - Catherine Brewin
- School of Health Sciences, University of Nottingham, Nottingham, United Kingdom.,Health Care of Older People, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - Rowan H Harwood
- School of Health Sciences, University of Nottingham, Nottingham, United Kingdom, .,Health Care of Older People, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom,
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19
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Cho E, Kim S, Hwang S, Kwon E, Heo SJ, Lee JH, Ye BS, Kang B. Factors Associated With Behavioral and Psychological Symptoms of Dementia: Prospective Observational Study Using Actigraphy. J Med Internet Res 2021; 23:e29001. [PMID: 34714244 PMCID: PMC8590188 DOI: 10.2196/29001] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 06/07/2021] [Accepted: 09/27/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Although disclosing the predictors of different behavioral and psychological symptoms of dementia (BPSD) is the first step in developing person-centered interventions, current understanding is limited, as it considers BPSD as a homogenous construct. This fails to account for their heterogeneity and hinders development of interventions that address the underlying causes of the target BPSD subsyndromes. Moreover, understanding the influence of proximal factors-circadian rhythm-related factors (ie, sleep and activity levels) and physical and psychosocial unmet needs states-on BPSD subsyndromes is limited, due to the challenges of obtaining objective and/or continuous time-varying measures. OBJECTIVE The aim of this study was to explore factors associated with BPSD subsyndromes among community-dwelling older adults with dementia, considering sets of background and proximal factors (ie, actigraphy-measured sleep and physical activity levels and diary-based caregiver-perceived symptom triggers), guided by the need-driven dementia-compromised behavior model. METHODS A prospective observational study design was employed. Study participants included 145 older adults with dementia living at home. The mean age at baseline was 81.2 (SD 6.01) years and the sample consisted of 86 (59.3%) women. BPSD were measured with a BPSD diary kept by caregivers and were categorized into seven subsyndromes. Independent variables consisted of background characteristics and proximal factors (ie, sleep and physical activity levels measured using actigraphy and caregiver-reported contributing factors assessed using a BPSD diary). Generalized linear mixed models (GLMMs) were used to examine the factors that predicted the occurrence of BPSD subsyndromes. We compared the models based on the Akaike information criterion, the Bayesian information criterion, and likelihood ratio testing. RESULTS Compared to the GLMMs with only background factors, the addition of actigraphy and diary-based data improved model fit for every BPSD subsyndrome. The number of hours of nighttime sleep was a predictor of the next day's sleep and nighttime behaviors (odds ratio [OR] 0.9, 95% CI 0.8-1.0; P=.005), and the amount of energy expenditure was a predictor for euphoria or elation (OR 0.02, 95% CI 0.0-0.5; P=.02). All subsyndromes, except for euphoria or elation, were significantly associated with hunger or thirst and urination or bowel movements, and all BPSD subsyndromes showed an association with environmental change. Age, marital status, premorbid personality, and taking sedatives were predictors of specific BPSD subsyndromes. CONCLUSIONS BPSD are clinically heterogeneous, and their occurrence can be predicted by different contributing factors. Our results for various BPSD suggest a critical window for timely intervention and care planning. Findings from this study will help devise symptom-targeted and individualized interventions to prevent and manage BPSD and facilitate personalized dementia care.
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Affiliation(s)
- Eunhee Cho
- Mo-Im Kim Nursing Research Institute, College of Nursing, Yonsei University, Seoul, Republic of Korea
| | - Sujin Kim
- College of Nursing, Yonsei University, Seoul, Republic of Korea
| | - Sinwoo Hwang
- Korea Armed Forces Nursing Academy, Daejeon, Republic of Korea
| | - Eunji Kwon
- Korea Armed Forces Nursing Academy, Daejeon, Republic of Korea
| | - Seok-Jae Heo
- Department of Biostatistics and Computing, Yonsei University Graduate School, Yonsei University, Seoul, Republic of Korea
| | - Jun Hong Lee
- National Health Insurance Service, Ilsan Hospital, Goyang, Republic of Korea
| | - Byoung Seok Ye
- College of Medicine, Yonsei University, Seoul, Republic of Korea
| | - Bada Kang
- Mo-Im Kim Nursing Research Institute, College of Nursing, Yonsei University, Seoul, Republic of Korea
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20
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Jeong HJ, Lee YM, Park JM, Lee BD, Moon E, Suh H, Kim HJ, Pak K, Choi KU, Chung YI. Reduced Thickness of the Anterior Cingulate Cortex as a Predictor of Amnestic-Mild Cognitive Impairment Conversion to Alzheimer's Disease with Psychosis. J Alzheimers Dis 2021; 84:1709-1717. [PMID: 34719496 DOI: 10.3233/jad-215005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND A long-term follow-up study in patients with amnestic mild cognitive impairment (aMCI) is needed to elucidate the association between regional brain volume and psychopathological mechanisms of Alzheimer's disease with psychosis (AD + P). OBJECTIVE The purpose of this study was to investigate the effect of the thickness of the angular cingulate cortex (ACC) on the risk of AD + P conversion in patients with aMCI. METHODS This was a hospital-based prospective longitudinal study including 174 patients with aMCI. The main outcome measure was time-to-progression from aMCI to AD + P. Subregions of the ACC (rostral ACC, rACC; caudal ACC, cACC) and hippocampus (HC) were measured as regions of interest with magnetic resonance imaging and the Freesurfer analysis at baseline. Survival analysis with time to incident AD + P as an event variable was calculated with Cox proportional hazards models using the subregions of the ACC and HC as a continuous variable. RESULTS Cox proportional hazard analyses showed that the risk of AD + P was associated with sub-regional ACC thickness but not HC volume: reduced cortical thickness of the left cACC (HR [95%CI], 0.224 [0.087-0.575], p = 0.002), right cACC (HR [95%CI], 0.318 [0.132-0.768], p = 0.011). This association of the cACC with the risk of AD also remained significant when adjusted for HC volume. CONCLUSION We found that reduced cortical thickness of the cACC is a predictor of aMCI conversion to AD + P, independent of HC, suggesting that the ACC plays a vital role in the underlying pathogenesis of AD + P.
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Affiliation(s)
- Hee-Jeong Jeong
- Department of Psychiatry, Pusan National University School of Medicine, Busan, Republic of Korea.,Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
| | - Young-Min Lee
- Department of Psychiatry, Pusan National University School of Medicine, Busan, Republic of Korea.,Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
| | - Je-Min Park
- Department of Psychiatry, Pusan National University School of Medicine, Busan, Republic of Korea.,Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
| | - Byung-Dae Lee
- Department of Psychiatry, Pusan National University School of Medicine, Busan, Republic of Korea.,Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
| | - Eunsoo Moon
- Department of Psychiatry, Pusan National University School of Medicine, Busan, Republic of Korea.,Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
| | - Hwagyu Suh
- Department of Psychiatry, Pusan National University School of Medicine, Busan, Republic of Korea.,Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
| | - Hak-Jin Kim
- Department of Radiology, Pusan National University School of Medicine, Busan, Republic of Korea
| | - Kyoungjune Pak
- Department of Nuclear Medicine, Pusan National University School of Medicine, Busan, Republic of Korea
| | - Kyung-Un Choi
- Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea.,Department of Pathology, Pusan National University School of Medicine, Busan, Republic of Korea
| | - Young-In Chung
- Department of Psychiatry, Pusan National University School of Medicine, Yangsan, Republic of Korea
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21
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Kim HJ, Cho KR, Jang H, Lee NK, Jung YH, Kim JP, Lee JI, Chang JW, Park S, Kim ST, Moon SW, Seo SW, Choi SJ, Na DL. Intracerebroventricular injection of human umbilical cord blood mesenchymal stem cells in patients with Alzheimer's disease dementia: a phase I clinical trial. ALZHEIMERS RESEARCH & THERAPY 2021; 13:154. [PMID: 34521461 PMCID: PMC8439008 DOI: 10.1186/s13195-021-00897-2] [Citation(s) in RCA: 59] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 09/02/2021] [Indexed: 12/22/2022]
Abstract
Backgrounds Alzheimer’s disease is the most common cause of dementia, and currently, there is no disease-modifying treatment. Favorable functional outcomes and reduction of amyloid levels were observed following transplantation of mesenchymal stem cells (MSCs) in animal studies. Objectives We conducted a phase I clinical trial in nine patients with mild-to-moderate Alzheimer’s disease dementia to evaluate the safety and dose-limiting toxicity of three repeated intracerebroventricular injections of human umbilical cord blood–derived MSCs (hUCB-MSCs). Methods We recruited nine mild-to-moderate Alzheimer’s disease dementia patients from Samsung Medical Center, Seoul, Republic of Korea. Four weeks prior to MSC administration, the Ommaya reservoir was implanted into the right lateral ventricle of the patients. Three patients received a low dose (1.0 × 107 cells/2 mL), and six patients received a high dose (3.0 × 107 cells/2 mL) of hUCB-MSCs. Three repeated injections of MSCs were performed (4-week intervals) in all nine patients. These patients were followed up to 12 weeks after the first hUCB-MSC injection and an additional 36 months in the extended observation study. Results After hUCB-MSC injection, the most common adverse event was fever (n = 9) followed by headache (n = 7), nausea (n = 5), and vomiting (n = 4), which all subsided within 36 h. There were three serious adverse events in two participants that were considered to have arisen from the investigational product. Fever in a low dose participant and nausea with vomiting in another low dose participant each required extended hospitalization by a day. There were no dose-limiting toxicities. Five participants completed the 36-month extended observation study, and no further serious adverse events were observed. Conclusions Three repeated administrations of hUCB-MSCs into the lateral ventricle via an Ommaya reservoir were feasible, relatively and sufficiently safe, and well-tolerated. Currently, we are undergoing an extended follow-up study for those who participated in a phase IIa trial where upon completion, we hope to gain a deeper understanding of the clinical efficacy of MSC AD therapy. Trial registration ClinicalTrials.gov NCT02054208. Registered on 4 February 2014. ClinicalTrials.gov NCT03172117. Registered on 1 June 2017 Supplementary Information The online version contains supplementary material available at 10.1186/s13195-021-00897-2.
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Affiliation(s)
- Hee Jin Kim
- Departments of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 80 Ilwon-ro, Gangnam-gu, Seoul, 135-710, Republic of Korea.,Alzheimer's Disease Convergence Research Center, Samsung Medical Center, Seoul, Republic of Korea.,Neuroscience Center, Samsung Medical Center, Seoul, Republic of Korea.,Stem Cell & Regenerative Medicine Institute, Samsung Medical Center, Seoul, Republic of Korea.,Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea
| | - Kyung Rae Cho
- Department of Neurosurgery, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Hyemin Jang
- Departments of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 80 Ilwon-ro, Gangnam-gu, Seoul, 135-710, Republic of Korea.,Alzheimer's Disease Convergence Research Center, Samsung Medical Center, Seoul, Republic of Korea.,Neuroscience Center, Samsung Medical Center, Seoul, Republic of Korea.,Stem Cell & Regenerative Medicine Institute, Samsung Medical Center, Seoul, Republic of Korea
| | - Na Kyung Lee
- Alzheimer's Disease Convergence Research Center, Samsung Medical Center, Seoul, Republic of Korea.,Stem Cell & Regenerative Medicine Institute, Samsung Medical Center, Seoul, Republic of Korea.,Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Young Hee Jung
- Department of Neurology, Myongji Hospital, Hanyang University, Goyang, Republic of Korea
| | - Jun Pyo Kim
- Center for Neuroimaging, Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Jung Il Lee
- Neuroscience Center, Samsung Medical Center, Seoul, Republic of Korea.,Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jong Wook Chang
- Stem Cell & Regenerative Medicine Institute, Samsung Medical Center, Seoul, Republic of Korea.,Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea
| | - Seongbeom Park
- Departments of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 80 Ilwon-ro, Gangnam-gu, Seoul, 135-710, Republic of Korea.,Alzheimer's Disease Convergence Research Center, Samsung Medical Center, Seoul, Republic of Korea.,Neuroscience Center, Samsung Medical Center, Seoul, Republic of Korea
| | - Sung Tae Kim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Seung Whan Moon
- Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sang Won Seo
- Departments of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 80 Ilwon-ro, Gangnam-gu, Seoul, 135-710, Republic of Korea.,Alzheimer's Disease Convergence Research Center, Samsung Medical Center, Seoul, Republic of Korea.,Neuroscience Center, Samsung Medical Center, Seoul, Republic of Korea
| | - Soo Jin Choi
- Biomedical Research Institute, R&D Center, MEDIPOST Co., Ltd., Seongnam, Republic of Korea
| | - Duk L Na
- Departments of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 80 Ilwon-ro, Gangnam-gu, Seoul, 135-710, Republic of Korea. .,Alzheimer's Disease Convergence Research Center, Samsung Medical Center, Seoul, Republic of Korea. .,Neuroscience Center, Samsung Medical Center, Seoul, Republic of Korea. .,Stem Cell & Regenerative Medicine Institute, Samsung Medical Center, Seoul, Republic of Korea. .,Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea.
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22
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Lee EJ, Kim SJ, Lee SH, Jang JW, Jhoo JH, Lee JH. Relationship of Subjective and Objective Sleep Quality with Caregiver Burden in Patients with Alzheimer’s Disease. SLEEP MEDICINE RESEARCH 2021. [DOI: 10.17241/smr.2020.00843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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23
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Extra-basal ganglia iron content and non-motor symptoms in drug-naïve, early Parkinson's disease. Neurol Sci 2021; 42:5297-5304. [PMID: 33860863 PMCID: PMC8642382 DOI: 10.1007/s10072-021-05223-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Accepted: 03/23/2021] [Indexed: 11/30/2022]
Abstract
Background Although iron dyshomeostasis is associated with Parkinson’s disease (PD) pathogenesis, the relationship between iron deposition and non-motor involvement in PD is not fully understood. In this study, we investigated basal ganglia and extra-basal ganglia system iron contents and their correlation with non-motor symptoms in drug-naïve, early-stage PD patients. Methods We enrolled 14 drug-naïve, early-stage PD patients and 12 age/sex-matched normal controls. All participants underwent brain magnetic resonance imaging to obtain the effective transverse relaxation rate (R2*) and quantitative susceptibility mapping (QSM). Deep brain structures, including the nucleus accumbens, caudate nucleus, putamen, globus pallidus, thalamus, hippocampus, and amygdala, were delineated using the FSL-FIRST; the substantia nigra, red nucleus, and dentate nucleus were segmented manually. Inter-group differences in R2* and QSM values, as well as their association with clinical parameters of PD, were investigated. Results Substantia nigra and putamen R2* values were significantly higher in PD patients than in normal controls, despite no significant difference in QSM values. Regarding the non-motor symptom scales, PD sleep scale score negatively correlated with R2* values in the red nucleus and right amygdala, Scales for Outcomes in Parkinson’s disease-Autonomic scores were positively correlated with R2* values in the right amygdala and left hippocampus, and cardiovascular sub-score of Non-Motor Symptoms Scale for PD was positively associated with the QSM value in the left hippocampus. Conclusion In this study, iron content in the extra-basal ganglia system was significantly correlated with non-motor symptoms, especially sleep problems and dysautonomia, even in early-stage PD. Supplementary Information The online version contains supplementary material available at 10.1007/s10072-021-05223-0.
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24
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Byeon GH, Kim WJ, Byun MS, Lee JH, Jeon SY, Ko K, Sung K, Han D, Joung H, Lee Y, Jung G, Lee HN, Yi D, Lee DY. Validation of the Korean Version of the Anosognosia Questionnaire for Dementia. Psychiatry Investig 2021; 18:324-331. [PMID: 33951779 PMCID: PMC8103024 DOI: 10.30773/pi.2020.0364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Accepted: 01/04/2021] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE Anosognosia is a common phenomenon in individuals with dementia. Anosognosia Questionnaire for dementia (AQ-D) is a well-known scale for evaluating anosognosia. This study aimed to establish a Korean version of the AQ-D (AQ-D-K) and to evaluate the reliability and validity of the AQ-D-K in patients with Alzheimer's disease (AD) dementia. METHODS We translated the original English version of AQ-D into Korean (AQ-D-K). Eighty-four subjects with very mild or mild AD dementia and their caregivers participated. Reliability of AQ-D-K was assessed by internal consistency and one-month test-retest reliability. Construct validity and concurrent validity were also evaluated. RESULTS Internal consistencies of the AQ-D-K patient form and caregiver form were high (Cronbach alpha 0.95 and 0.93, respectively). The test-retest reliability of AQ-D-K measured by intra-class correlation coefficient was 0.84. Three factors were identified: 1) anosognosia of instrumental activity of daily living; 2) anosognosia basic activity of daily living; and 3) anosognosia of depression and disinhibition. AQ-D-K score was significantly correlated with the clinician-rated anosognosia rating scale (ARS), center for epidemiological studies-depression scale (CES-D) and state-trait anxiety inventory (STAI). CONCLUSION The findings suggest that the AQ-D-K is a reliable and valid scale for evaluating anosognosia for AD dementia patients using Korean language.
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Affiliation(s)
- Gi Hwan Byeon
- Department of Neuropsychiatry, Kangwon National University Hospital, Chuncheon, Republic of Korea
| | - Woo Jin Kim
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Republic of Korea
| | - Min Soo Byun
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Jun Ho Lee
- Department of Psychiatry, National Center for Mental Health, Seoul, Republic of Korea
| | - So Yeon Jeon
- Department of Neuropsychiatry, Chungnam National University Hospital, Daejeon, Republic of Korea
| | - Kang Ko
- Department of Psychiatry, National Center for Mental Health, Seoul, Republic of Korea
| | - Kiyoung Sung
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Republic of Korea
| | - Dongkyun Han
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Republic of Korea
| | - Haejung Joung
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Republic of Korea
| | - Younghwa Lee
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Republic of Korea
| | - Gijung Jung
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Republic of Korea
| | - Han Na Lee
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Republic of Korea
| | - Dahyun Yi
- Institute of Human Behavioral Medicine, Medical Research Center, Seoul National University, Seoul, Republic of Korea
| | - Dong Young Lee
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Republic of Korea.,Institute of Human Behavioral Medicine, Medical Research Center, Seoul National University, Seoul, Republic of Korea.,Department of Psychiatry, Seoul National University of College of Medicine, Seoul, Republic of Korea
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25
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Kim B, Noh GO, Kim K. Behavioural and psychological symptoms of dementia in patients with Alzheimer's disease and family caregiver burden: a path analysis. BMC Geriatr 2021; 21:160. [PMID: 33663416 PMCID: PMC7934246 DOI: 10.1186/s12877-021-02109-w] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 02/18/2021] [Indexed: 11/25/2022] Open
Abstract
Background Studies reported the relationship between behavioural and psychological symptoms of dementia (BPSD), cognitive function, caregiver burden, and therapeutic effects. However, the causal relationship between BPSD in community-dwelling patients with Alzheimer’s disease (AD) and caregiver burden is yet to be established. This study aimed to classify BPSD in patients with AD and identify the relationship between BPSD and the factors affecting family caregiver burden. Methods Path analysis was conducted at a neurology outpatient clinic of a tertiary general hospital in South Korea. The medical records of 170 patients, aged ≥50 years, diagnosed with or suspected for AD were retrospectively reviewed. We investigated cognitive function (Korean version of the Mini-Mental-State Exam), dementia stages (Korean version of the Expanded Clinical Dementia Rating scale), depression (Short-form Geriatric Depression Scale-Korea), activities of daily living (ADL; Korean version of the Barthel Activities of Daily Living index), instrumental activities of daily living (IADL; Seoul-Instrumental Activities of Daily Living), and BPSD and caregiver burden (Korean Neuropsychiatric Inventory). Considering the characteristic features of BPSD with various symptoms, BPSD was classified using factor analysis. Factor extraction was performed using principal component analysis, followed by Varimax factor rotation. Results Mean total BPSD score was 17.66 ± 20.67, and the mean score for family caregiver burden was 9.65 ± 11.12. Symptom cluster-1 (hyperactivity symptoms) included disinhibition, irritability, and agitation/aggression. Symptom cluster-2 (psychosis symptoms) included hallucinations, anxiety, elation/euphoria, delusions, and depression/dysphoria. Symptom cluster-3 (physical behaviour symptoms) included appetite and eating abnormalities, apathy/indifference, aberrant motor behaviour, sleep, and night-time behaviour disturbances. Dementia stages, ADL, and IADL had indirect effects on family caregiver burden through hyperactivity, psychosis, and physical behaviour symptoms, indicating that BPSD exerted a complete mediating effect. Conclusions Unlike previous studies, we classified BPSD symptoms into similar symptom clusters to evaluate its effect on caregiver burden, rather than collectively investigating the 12 symptoms of BPSD. As the dementia stage worsens, symptom clusters in BPSD serve as a medium between ADL and IADL degradation and for the increase in caregivers’ burden. The development and implementation of therapeutic, nursing interventions, and policies focusing on dementia stages, ADL, and IADL, delaying and preventing BPSD can alleviate family caregivers’ burden.
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Affiliation(s)
- Bokyoung Kim
- Department of Nursing, Catholic Kwandong University, Gangneung, South Korea
| | - Gie Ok Noh
- Department of Nursing, Konyang University, 158 Gwanjeodong-ro, Seo-gu, Daejeon, 35365, South Korea.
| | - Kyunghee Kim
- Department of Nursing, Chung-Ang University, Seoul, South Korea
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26
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Youn H, Lee KJ, Kim SG, Cho SJ, Kim WJ, Lee WJ, Hwang JY, Han C, Shin C, Jung HY. The Behavioral Effects of Combination Therapy of Memantine and Acetylcholinesterase Inhibitors Compared with Acetylcholinesterase Inhibitors Alone in Patients with Moderate Alzheimer's Dementia: A Double-Blind Randomized Placebo-Controlled Trial. Psychiatry Investig 2021; 18:233-240. [PMID: 33685036 PMCID: PMC8016683 DOI: 10.30773/pi.2020.0329] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 01/13/2021] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE This study aimed to investigate treatment effects of combination therapy of memantine and acetylcholinesterase inhibitors (AchEIs) compared with AchEIs alone on behavioral and psychological symptoms of dementia (BPSD) in patients with moderate Alzheimer's dementia (AD). METHODS This was a 12-week, double-blind, randomized, placebo-controlled trial. A total of 148 patients with moderate AD participated in this study. Mini-Mental State Examination, Neuropsychiatric Inventory (NPI), Clinician's Interview-Based Impression of Change plus caregiver input, Gottfries-Bråne-Steen Scale, and Zarit Burden Interview were used as assessment scales. RESULTS There were no significant differences in age, sex, or education between AChEIs alone and combination groups. The combination group showed significantly more improvement of NPI-disinhibition score (0.76±2.15) than the AChEIs alone group (-0.14±1.71) after 12 weeks. CONCLUSION Our findings suggest that the combination therapy of memantine and AchEIs might be a beneficial option for reducing disinhibition symptoms of patients with moderate AD compared with AchEIs alone. We believe that clinicians need to consider additional memantine treatment when patients with moderate AD complain disinhibition symptom. A larger clinical trial is needed to further determine the efficacy and advantages of such combination therapy of memantine and AchEIs for treating BPSD of patients with moderate AD.
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Affiliation(s)
- HyunChul Youn
- Department of Psychiatry, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
| | - Kang Joon Lee
- Department of Psychiatry, Ilsanpaik Hospital, Inje University College of Medicine, Goyang, Republic of Korea
| | - Shin-Gyeom Kim
- Department of Psychiatry, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
| | - Seong-Jin Cho
- Department of Psychiatry, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
| | - Woo Jung Kim
- Department of Psychiatry, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Republic of Korea
| | - Won Joon Lee
- Department of Psychiatry, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Jae Yeon Hwang
- Department of Psychiatry, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Changsu Han
- Department of Psychiatry, Korea University College of Medicine, Seoul, Republic of Korea
| | - Cheolmin Shin
- Department of Psychiatry, Korea University College of Medicine, Seoul, Republic of Korea
| | - Han-Yong Jung
- Department of Psychiatry, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
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27
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Lee JS, Kim JH, Lee SK. The Relationship between Neuropsychiatric Symptoms and Default-Mode Network Connectivity in Alzheimer's Disease. Psychiatry Investig 2020; 17:662-666. [PMID: 32571002 PMCID: PMC7385213 DOI: 10.30773/pi.2020.0009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 04/07/2020] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE Neuropsychiatric symptoms of dementia are prevalent and extremely burdening for the patient and caregivers, but the underlying mechanism of these symptoms has not been investigated. This study aimed to investigate the relationship between neuropsychiatric symptoms and default-mode functional connectivity in Alzheimer's disease. METHODS Neuropsychiatric symptoms were assessed using the Neuropsychiatric Inventory. Functional magnetic resonance imaging was conducted on seventy patients with Alzheimer's disease during rest. We conducted a seed-based functional connectivity analysis to identify anterior and posterior default-mode networks (DMN). Seeds were the medial prefrontal cortex (Montreal Neurological Institute 12, 51, 36; seed radius=3 mm) for the anterior DMN and the precuneus (Montreal Neurological Institute -6, -63, 27; seed radius=3 mm) for the posterior DMN We then correlated the scores on neuropsychiatric inventory syndromes (apathy, hyperactivity, affective, and psychosis syndrome) with maps of connectivity in the default-mode network. RESULTS There was a significant correlation between decreased connectivity in the medial prefrontal cortex of the anterior defaultmode network and hyperactivity (agitation, irritability, aberrant motor behavior, euphoria, and disinhibition) syndrome (p<0.05, family wise error cluster-level corrected). CONCLUSION Our study demonstrated that hyperactivity syndrome is related to hypoconnected default-mode network in Alzheimer's disease. This finding suggests that specific network alterations are associated with certain neuropsychiatric syndromes.
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Affiliation(s)
- Jung Suk Lee
- Dementia Center, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea.,Department of Psychiatry, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea
| | - Jong Hun Kim
- Dementia Center, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea.,Department of Neurology, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea
| | - Seon-Koo Lee
- Department of Psychiatry, Bundang Jesaeng Hospital, Seongnam, Republic of Korea
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28
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Choi JH, Lee JY, Jeon B, Koh SB, Yoon WT, Lee HW, Kwon OD, Kim JW, Kim JM, Ma HI, Kim HT, Baik JS, Cho JW. Neuropsychiatric Traits Associated with Refractory Impulse Control Disorder in Parkinson's Disease. NEURODEGENER DIS 2020; 19:171-177. [PMID: 32454490 DOI: 10.1159/000507447] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 03/20/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Impulse control disorder (ICD) in Parkinson's disease (PD) is a critical nonmotor symptom with personality or neuropsychiatric traits contributing to ICD. OBJECTIVE This study aimed to identify predictive traits for persistent or paradoxical aggravation of ICD after dopamine agonist substitution therapy for ICD in PD. METHODS We conducted a case-control study using a database of a multicenter intervention trial for ICD in PD. The poor-outcome group was defined by showing paradoxical increases in ICD behaviors after the substitution of dopamine agonists with levodopa. We analyzed the pre-intervention personality traits associated with the poor outcome and also evaluated the risk traits for refractory ICD using a receiver-operating characteristic (ROC) curve analysis. RESULTS The poor-outcome group showed higher levels of anger expression (p =0.007) and obsessive-compulsive traits (p =0.009) compared with the good-outcome group at the pre-intervention state. In the ROC curve analysis, the Obsessive-Compulsive Inventory showed the highest area under the curve with 80.0% sensitivity and 74.3% specificity in discriminating against the poor-outcome group. CONCLUSIONS Our results suggest that assessment of obsessive compulsiveness may be useful for predicting the refractoriness of ICD behaviors in planning an interventional treatment for ICD in PD.
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Affiliation(s)
- Ji-Hyun Choi
- Department of Neurology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Republic of Korea.,Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jee-Young Lee
- Department of Neurology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Republic of Korea,
| | - Beomseok Jeon
- Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Seong-Beom Koh
- Department of Neurology, Korea University Guro Hospital, Seoul, Republic of Korea
| | - Won Tae Yoon
- Department of Neurology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Ho-Won Lee
- Department of Neurology, School of Medicine, Kyungpook National University, and Brain Science and Engineering Institute, Kyungpook National University, Daegu, Republic of Korea
| | - Oh Dae Kwon
- Department of Neurology, Daegu Catholic University Medical Center, Daegu, Republic of Korea
| | - Jae Woo Kim
- Department of Neurology, Dong-A University Hospital, Pusan, Republic of Korea
| | - Jong-Min Kim
- Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Hyeo-Il Ma
- Department of Neurology, Hallym University Hospital, Anyang, Republic of Korea
| | - Hee Tae Kim
- Department of Neurology, Hanyang University Medical Center, Seoul, Republic of Korea
| | - Jong Sam Baik
- Department of Neurology, Inje University Sanggye Paik Hospital, Seoul, Republic of Korea
| | - Jin Whan Cho
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Moon S, Park K. The effect of digital reminiscence therapy on people with dementia: a pilot randomized controlled trial. BMC Geriatr 2020; 20:166. [PMID: 32375661 PMCID: PMC7204054 DOI: 10.1186/s12877-020-01563-2] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Accepted: 04/20/2020] [Indexed: 12/31/2022] Open
Abstract
Background Reminiscence therapy (RT) can improve various dysfunctions in people with dementia (PWD), but it may not be a cost-effective intervention. Digital RT allows multiple users to participate in a therapy simultaneously. Moreover, digital RT offers convenience, such as for uploading personal materials and presenting individual triggers of personal memories. This pilot study aimed to evaluate the effect of digital RT through a comparison with conventional RT and to develop a strategy for designing larger RCTs. Methods An Android application and digital content were developed for digital RT. Overall, 49 PWD enrolled in nine daycare centers in Korea met the inclusion criteria. Eight sessions of digital RT in an intervention group (n = 25) and storytelling in a control group (n = 24) with no digital materials were performed over 4 weeks from February to June 2019. Cognition, depression, behavioral and psychological symptoms of dementia (BPSD), and engagement were measured as the primary outcomes to evaluate the effect of digital RT. All outcomes except for engagement were evaluated at baseline before the intervention (T0), post-intervention (T1), and 4 weeks after the intervention (T2). Engagement was measured at the first and last intervention sessions. Differences in cognition, depression and BPSD between groups and across time points (T0, T1, and T2) were analyzed by repeated measures ANOVA. Differences in engagement between the groups and time points (the first and last sessions) were analyzed by independent t-tests. This study adhered to the CONSORT guidelines. Results Depression (F = 7.62, p = .001, partial η2 = .17) was significantly decreased at T1 and T2, and engagement (t = − 2.71, p = .011) was significantly increased at the last session in the digital RT group compared to the control group. However, cognition (F = 0.13, p = .821) and BPSD (F = 0.67, p = .485) were not significantly different between groups and time points. Conclusions Digital RT proved an innovative approach to manage PWD and will thus help PWD achieve a better mood and have more opportunities to engage in social interactions. Trial registration KCT0003446 in the Clinical Research Information Service. Registered 24 January 2019, https://cris.nih.go.kr/cris/search/search_result_st01.jsp?seq=14391
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Affiliation(s)
- SeolHwa Moon
- College of Nursing, Hanyang University, 222 Wangsimni-ro, Sungdong-gu, Seoul, 04763, Korea
| | - Kyongok Park
- Department of Nursing, Gangneung-Wonju National University, 150 Namwon-ro, Heungeop-myeon, Wonju-si, Gangwon-do, 26403, Korea.
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30
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Park E, Park H, Kim EK. The effect of a comprehensive mobile application program (CMAP) for family caregivers of home-dwelling patients with dementia: A preliminary research. Jpn J Nurs Sci 2020; 17:e12343. [PMID: 32363664 DOI: 10.1111/jjns.12343] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 03/03/2020] [Accepted: 04/07/2020] [Indexed: 01/01/2023]
Abstract
AIM The purpose of this study was to evaluate the effect of a comprehensive mobile application program in managing behavior and psychological symptoms of home-dwelling patients with dementia in South Korea. METHODS A nonequivalent control group pretest-posttest design was conducted. A total of 26 family caregivers participated in this study. The application program consists of understanding of dementia, interventions, communication skills, coping methods, and bulletin boards. Data collection was performed from July 9, 2018, to October 4, 2018. Family caregivers' fatigue, sleep, and burden and patients with behavioral and psychological symptoms of dementia were measured. For data analysis, descriptive statistics, independent t tests, Mann-Whitney U test, repeated measures analysis of variance, and Friedman test were used. RESULTS The application program offered environmental management in an intervention using communication skills and coping methods, depending on the behavioral and psychological symptom type. The results showed significant differences between the two groups in family caregivers' fatigue (F = 11.24, p = .003) and burden (χ2 = 10.55, p = .005). CONCLUSION The findings showed the application program improved family caregivers' fatigue and burden. It also suggested there is a need to develop a wandering persons location program to improve family caregivers' stress and patients' behavioral problems in future studies.
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Affiliation(s)
- Eunsil Park
- Department of Nursing, Yeungjin University, Daegu, South Korea
| | - Heeok Park
- College of Nursing, Research Institute of Nursing Science, Keimyung University, Daegu, South Korea
| | - Eun Kyung Kim
- College of Nursing, Research Institute of Nursing Science, Keimyung University, Daegu, South Korea
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Abstract
REASONS FOR THE STUDY The Neuropsychiatric Inventory (NPI) has been used for studies of neuropsychiatric symptoms in neurodegenerative disorders for the past 25 years. This article reviews the history of the development and application of the NPI. MAIN FINDINGS The NPI consists of 10 (or 12) items that are assayed with questions, subquestions, and ratings of frequency and severity. The NPI has been shown to be valid and reliable. The NPI has been translated into approximately 40 languages; it has 4 of versions designed for different clinical applications. The NPI studies show contrasting profiles of behavioral symptoms in different neurologic disorders. The NPI has been used in approximately 350 clinical trials. In economic studies, the NPI captures the cost of behavioral symptoms in dementias. PRINCIPLE CONCLUSIONS The NPI is a useful instrument for capturing behavioral changes in Alzheimer disease and other neurodegenerative disorders.
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Affiliation(s)
- Jeffrey Cummings
- Department of Brain Health, School of integrated Health Sciences, UNLV, Las Vegas, NV, USA,Lou Ruvo Center for Brain Health, Cleveland Clinic, Las Vegas, NV, USA
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Yoon B, Choi SH, Jeong JH, Park KW, Kim EJ, Hwang J, Jang JW, Kim HJ, Hong JY, Lee JM, Kang JH, Yoon SJ. Balance and Mobility Performance Along the Alzheimer’s Disease Spectrum. J Alzheimers Dis 2020; 73:633-644. [DOI: 10.3233/jad-190601] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Bora Yoon
- Department of Neurology, Konyang University College of Medicine, Daejeon, Korea
| | - Seong Hye Choi
- Department of Neurology, Inha University School of Medicine, Incheon, Korea
| | - Jee Hyang Jeong
- Department of Neurology, Ewha Womans University School of Medicine, Seoul, Korea
| | - Kyung Won Park
- Department of Neurology, Dong-A Medical Center, Dong-A University College of Medicine, Busan, Korea
| | - Eun-Joo Kim
- Department of Neurology, Pusan National University Hospital, Pusan National University School of Medicine and Medical Research Institute, Busan, Korea
| | - Jihye Hwang
- Department of Neurology, Keimyung University Dongsan Medical Center, Daegu, Korea
| | - Jae-Won Jang
- Department of Neurology, Kangwon National University Hospital, Kangwon National University College of Medicine, Chuncheon, Korea
| | - Hee Jin Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jin Yong Hong
- Department of Neurology, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Jong-Min Lee
- Department of Biomedical Engineering, Hanyang University, Seoul, Korea
| | - Ju-Hee Kang
- Department of Pharmacology, Inha University School of Medicine, Incheon, Korea
| | - Soo Jin Yoon
- Department of Neurology, Eulji University Hospital, Eulji University School of Medicine, Daejeon, Korea
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Lee YH, Bak Y, Park CH, Chung SJ, Yoo HS, Baik K, Jung JH, Sohn YH, Shin NY, Lee PH. Patterns of olfactory functional networks in Parkinson's disease dementia and Alzheimer's dementia. Neurobiol Aging 2019; 89:63-70. [PMID: 31980278 DOI: 10.1016/j.neurobiolaging.2019.12.021] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 12/24/2019] [Accepted: 12/24/2019] [Indexed: 12/29/2022]
Abstract
Hyposmia is common in Alzheimer's dementia (AD) and Parkinson's disease dementia (PDD). We evaluated the pattern of olfactory functional connectivity (FC) in AD and PDD to uncover neural correlates that are related to olfactory dysfunction. This study enrolled 57 patients with AD and PDD and 25 control subjects. Using a seed-based approach, we compared the resting-state network from the seed-region-of-interest in the olfactory bulb, olfactory tract, piriform cortex, and orbitofrontal cortex (OFC) between groups. The PDD group showed lower FC with striatal-thalamic-frontal regions from the olfactory bulb than the AD group. The PDD group showed lower FC from left OFC with striatal-frontal regions and lower FC from right OFC with left fronto-temporal areas than the AD group. In a correlation analysis, the FC from left OFC with right insula that differed between the PDD and control groups was positively correlated with olfactory function. The present study demonstrated that this distinct olfactory functional network pattern may represent different neural mechanisms for olfactory dysfunction in AD and PDD.
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Affiliation(s)
- Yang Hyun Lee
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Yunjin Bak
- Department of Radiology, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Chang-Hyun Park
- Department of Radiology, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Seok Jong Chung
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Han Soo Yoo
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Kyoungwon Baik
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Jin Ho Jung
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Young H Sohn
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Na-Young Shin
- Department of Radiology, College of Medicine, The Catholic University of Korea, Seoul, South Korea.
| | - Phil Hyu Lee
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea; Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, South Korea.
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Youn H, Lee S, Han C, Kim SH, Jeong HG. Association between brain amyloid accumulation and neuropsychological characteristics in elders with depression and mild cognitive impairment. Int J Geriatr Psychiatry 2019; 34:1907-1915. [PMID: 31489705 DOI: 10.1002/gps.5209] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 08/31/2019] [Indexed: 11/11/2022]
Abstract
OBJECTIVES To investigate the presence of cerebral amyloidopathy and its associations with performances on neurocognitive tests and clinical features in depressed elders with mild cognitive impairment (MCI). METHODS/DESIGN In total, 94 older adults with concomitant MCI and some depressive symptoms were included in this study. Cerebral amyloidopathy was evaluated using 18 F-florbetaben-positron emission tomography. A standardized neurocognitive test battery and brain magnetic resonance imaging (MRI) were administered to all subjects. We examined the Apolipoprotein E genotype using a polymerase chain reaction-based method. RESULTS Among the 94 initial participants, seven participants were excluded because of failure to undergo MRI or complete the neuropsychological battery. Among 87 subjects, 45 elders (51.7%) had cerebral amyloidopathy and were classified as the concomitant depression and MCI with cerebral amyloid-accumulation-positive (CDAP) group; others were classified as the concomitant depression and MCI with cerebral amyloid-accumulation-negative (CDAN) group. Poorer performances on word list recall and constructional recall were observed in the CDAP group than in the CDAN group. CONCLUSIONS The results indicate that around half of older adults with concomitant MCI and some depressive symptoms might be prone to have Alzheimer dementia. Results of neurocognitive tests possibly aid in discerning the presence of cerebral amyloidopathy.
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Affiliation(s)
- HyunChul Youn
- Department of Psychiatry, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Suji Lee
- Department of Biomedical Sciences, Korea University Graduate School, Seoul, Republic of Korea
| | - Changsu Han
- Department of Psychiatry, Korea University Ansan Hospital, Korea University College of Medicine, Gyeonggi-do, Republic of Korea
| | - Seung-Hyun Kim
- Department of Psychiatry, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Hyun-Ghang Jeong
- Department of Psychiatry, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea.,Korea University Research Institute of Mental Health, Republic of Korea
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Minn YK, Choi SH, Suh YJ, Jeong JH, Kim EJ, Kim JH, Park KW, Park MH, Youn YC, Yoon B, Choi SJ, Oh YK, Yoon SJ. Effect of Physical Activity on the Progression of Alzheimer's Disease: The Clinical Research Center for Dementia of South Korea Study. J Alzheimers Dis 2019; 66:249-261. [PMID: 30282355 DOI: 10.3233/jad-180333] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND There is a lack of research on the effects of physical activity (PA) on the progression of Alzheimer's disease (AD). OBJECTIVES We investigated whether PA is associated with progression of dementia and mortality in AD. METHODS In the present study, 934 patients with mild-to-moderate AD were included. PA was evaluated using a questionnaire written by the caregiver. The outcome measures were the Clinical Dementia Rating-Sum of Boxes (CDR-SB), Seoul-Instrumental Activities of Daily Living (S-IADL), Caregiver-Administered Neuropsychiatric Inventory (CGA-NPI), a global composite score of neuropsychological subtests, and mortality. They were evaluated annually and received a maximum of three follow-up examinations. RESULTS Between-group differences compared with the no PA group in the change of CDR-SB scores were -0.431 (95% CI = -0.824∼-0.039; p = 0.031) for the moderate PA group (150-750 minutes per week of moderate intensity PA), and -1.148 (-1.656∼-0.639; p < 0.001) for the high PA group (>750 minutes per week). As PA increased, there was a significant trend to slow the rate of increase in the CDR-SB, S-IADL, and CGA-NPI scores. The patients with ≥150 minutes per week for each of non-recreational and recreational PAs had a lower risk of mortality compared to those with <150 minutes per week for each of the PAs (hazard ratio 0.22, 95% CI = 0.05∼0.88; p = 0.033). CONCLUSION More PA is associated with slower progression of dementia severity, functional decline, and abnormal behavior, and with a lower risk of mortality in AD.
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Affiliation(s)
- Yang-Ki Minn
- Department of Neurology, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea
| | - Seong Hye Choi
- Department of Neurology, Inha University School of Medicine, Incheon, South Korea
| | - Young Ju Suh
- Department of Biomedical Sciences, Inha University School of Medicine, Incheon, South Korea
| | - Jee Hyang Jeong
- Department of Neurology, Ewha Womans University Mokdong Hospital, Ewha Womans University School of Medicine, Seoul, South Korea
| | - Eun-Joo Kim
- Department of Neurology, Pusan National University Hospital, Pusan National University School of Medicine, Busan, South Korea
| | - Jong Hun Kim
- Department of Neurology, National Health Insurance Service Ilsan Hospital, Goyang, South Korea
| | - Kyung Won Park
- Department of Neurology, Dong-A Medical Center, Dong-A University College of Medicine, Busan, South Korea
| | - Moon Ho Park
- Department of Neurology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, South Korea
| | - Young Chul Youn
- Department of Neurology, College of Medicine, Chung-Ang University, Seoul, South Korea
| | - Bora Yoon
- Department of Neurology, College of Medicine, Konyang University, Daejeon, South Korea
| | - Seok-Jin Choi
- Department of Neurology, Inha University School of Medicine, Incheon, South Korea
| | - Youn Kyung Oh
- Department of Biostatistics, Korea University College of Medicine, Seoul, South Korea
| | - Soo Jin Yoon
- Department of Neurology, Eulji University School of Medicine, Daejeon, South Korea
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Lee H, Kang JM, Myung W, Choi J, Lee C, Na DL, Kim SY, Lee JH, Han SH, Choi SH, Kim SY, Cho SJ, Yeon BK, Kim DK, Lewis M, Lee EM, Kim CT, Kim H. Exposure to ambient fine particles and neuropsychiatric symptoms in cognitive disorder: A repeated measure analysis from the CREDOS (Clinical Research Center for Dementia of South Korea) study. THE SCIENCE OF THE TOTAL ENVIRONMENT 2019; 668:411-418. [PMID: 30852217 DOI: 10.1016/j.scitotenv.2019.02.447] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Revised: 02/27/2019] [Accepted: 02/28/2019] [Indexed: 06/09/2023]
Abstract
There is a growing concern that air pollution, especially those particles <2.5 μm (PM2.5), could increase the risk of cognitive impairment and mental disorders. However, the relationship between ambient PM2.5 and neuropsychiatric symptoms in people with cognitive impairment is still undetermined. This longitudinal study included 645 pairs of cognitively impaired subjects, who had not changed residence within Seoul, and their caregivers from the Clinical Research Center for Dementia of South Korea study cohort between September 2005 and June 2010 (1763 days). Neuropsychiatric symptoms were measured by the Korean version of the Neuropsychiatry Inventory, and caregiver burden was examined by the Neuropsychiatry Inventory Caregiver Distress Scale at the first and second visits at the outpatient clinic. District-specific PM2.5 concentrations were constructed over 1 month to 1 year prior to each visit. A log-linear regression using generalized estimating equations to account for repeated measures was used to assess the relationship between PM2.5 exposure and neuropsychiatric symptoms or caregiver burden. Aggravated neuropsychiatric symptoms were associated with exposure to high PM2.5 levels (adjusted percent change: 16.7% [95% confidence interval (CI), 5.0-29.7] per 8.3 μg/m3 increase in 1-month moving averages). Increased caregiver burden was associated with high PM2.5 exposures only in caregivers for patients with Alzheimer's disease (adjusted percent change: 29.0% [95% CI, 8.1-53.9] per 8.3 μg/m3 increase in 1-month moving averages). The present results indicate that PM2.5 exposure is associated with aggravated neuropsychiatric symptoms and increased caregiver burden in subjects with cognitive impairment. The findings in this study suggest that the role of air pollution deserves great consideration in the aging population with cognitive impairment.
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Affiliation(s)
- Hyewon Lee
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Bundang-gu, Seongnam-si, Gyeonggi-do 13619, Republic of Korea; Institute of Health and Environment, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul 08826, Republic of Korea
| | - Jae Myeong Kang
- Department of Psychiatry, Gil Medical Center, Gachon University College of Medicine, Incheon 21565, Republic of Korea
| | - Woojae Myung
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Bundang-gu, Seongnam-si, Gyeonggi-do 13619, Republic of Korea.
| | - Junbae Choi
- Department of Psychiatry, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
| | - Chunsoo Lee
- Department of Psychiatry, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
| | - Duk L Na
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
| | - Seong Yoon Kim
- Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Republic of Korea
| | - Jae-Hong Lee
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Republic of Korea
| | - Seol-Heui Han
- Department of Neurology, Konkuk University School of Medicine, Seoul 05030, Republic of Korea
| | - Seong Hye Choi
- Department of Neurology, Inha University School of Medicine, Incheon 22332, Republic of Korea
| | - Sang Yun Kim
- Department of Neurology, Seoul National University Bundang Hospital, Bundang-gu, Seongnam-si, Gyeonggi-do 13619, Republic of Korea
| | - Seong-Jin Cho
- Department of Psychiatry, Gil Medical Center, Gachon University College of Medicine, Incheon 21565, Republic of Korea
| | - Byeong Kil Yeon
- Department of Psychiatry, Gil Medical Center, Gachon University College of Medicine, Incheon 21565, Republic of Korea
| | - Doh Kwan Kim
- Department of Psychiatry, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
| | - Matthew Lewis
- The Department of General Practice, Melbourne Medical School, The University of Melbourne, Victoria 3010, Australia
| | - Eun-Mi Lee
- Department of Health Science, Dongduk Women's University, 04620, Republic of Korea
| | - Clara Tammy Kim
- Institute of Life and Death Studies, Hallym University, Chuncheon, Gangwon-do, Republic of Korea
| | - Ho Kim
- Institute of Health and Environment, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul 08826, Republic of Korea; Department of Public Health Sciences, Graduate School of Public Health, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul 08826, Republic of Korea.
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Clinical and Demographic Predictors of Adverse Outcomes in Caregivers of Patients with Dementia. Dement Neurocogn Disord 2019; 18:10-18. [PMID: 31097968 PMCID: PMC6494781 DOI: 10.12779/dnd.2019.18.1.10] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 03/23/2019] [Accepted: 04/10/2019] [Indexed: 01/07/2023] Open
Abstract
Background and Purpose We aimed to elucidate independent predictors of adverse outcomes in caregivers of patients with dementia using readily available clinical and demographic data of patients with dementia and their caregivers. Methods We reviewed patient-caregiver data from the Clinical Research Center for Dementia of South Korea and Caregivers of Alzheimer Disease Research study. The clinical factors of the patients and the demographics of both patients and caregivers were used to predict adverse outcomes for caregivers. Correlation and linear regression analyses were performed. Results We enrolled 454 patients and their caregivers for the present study. The general burden for the caregiver was higher amongst female caregivers, patients with further decreased the level of activities of daily living (ADL), patients with more abnormal behavior, or younger patients. The time spent by the caregivers was more in cases of patients with higher Caregiver Administered Neuropsychiatric Inventory scores, younger patients and for patients with decreased level of ADL. Depression amongst caregivers was more prominent in patients with higher Clinical Dementia Rating Sum of Boxes scores. Physical health-related quality of life (HRQoL) was lower in female caregivers, more physically affected patients, and older caregivers. Lastly, mental HRQoL was lower in younger, more physically affected, and in patients with abnormal behaviors. Conclusions Clinical and demographic characteristics of patients and caregivers predict adverse outcomes for caregivers. Therefore, these factors should be considered to provide support to both patients and their caregivers.
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An JH, Lee KE, Jeon HJ, Son SJ, Kim SY, Hong JP. Risk of suicide and accidental deaths among elderly patients with cognitive impairment. ALZHEIMERS RESEARCH & THERAPY 2019; 11:32. [PMID: 30975186 PMCID: PMC6460725 DOI: 10.1186/s13195-019-0488-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 03/29/2019] [Indexed: 12/03/2022]
Abstract
Background The leading causes of death among the elderly with cognitive impairment are unknown. This study aims to estimate the suicide and accidental death rates on the basis of a clinical case registry of patients diagnosed with cognitive impairment. Methods The target sample consisted of 10,169 patients diagnosed with dementia or mild cognitive impairment (MCI), who were evaluated at the Clinical Research Center for Dementia of Korea (CREDOS) from January 2005 to December 2013. Information about whether the patients had died from suicide or in any kind of accident by December 31, 2016, was obtained from the database of the National Statistical Office (NSO). The standardized mortality ratio (SMR) and Cox-regression analysis were performed for evaluating the risk of suicide and accidental death as identified by the ICD-10. Results The average of the Clinical Dementia Rating Scale (CDR) score (0.68 vs 0.93) was lower, and the age at the time of study registration (71.42 vs 75.68 years) was younger in the suicidal death group, as compared to the accidental death group. The overall SMR for accidental death in cognitively impaired patients (1.44, 95% CI 1.22–1.71) was significantly higher than the general population. Later onset (1.43, 95% CI 1.20–1.71) and older age (2.21, 95% CI 1.04–4.68) increased the risk of accidental death in cognitively impaired patients. According to the dementia subtypes, the SMR for accidental death was higher in both Alzheimer’s disease (1.72, 95% CI 1.36–2.14) and vascular dementia (2.14, 95% CI 1.27–3.38). Additionally, the SMR for accidental death showed an increasing tendency as the CDR score increased (mild 1.80, 95% CI 1.32–2.42, moderate 1.86, 95% CI 1.07–3.03, severe 3.32, 95% CI 1.08–7.76). Unemployment increased the risks of both suicide (3.71, 95% CI 1.54–8.95) and accidental death (2.09, 95% CI 1.20–3.63). Conclusions Among people with cognitive impairment, the risk of death by suicide did not increase, whereas that of accidental death increased significantly. Preventive strategies for premature mortality in those with cognitive impairment should be implemented from the early stages and should include careful evaluation of the individual risk factors for each type of death.
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Affiliation(s)
- Ji Hyun An
- Department of Psychiatry, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro Gangnam-gu, Seoul, 06351, South Korea
| | - Kyung Eun Lee
- Department of Psychiatry, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro Gangnam-gu, Seoul, 06351, South Korea
| | - Hong Jin Jeon
- Department of Psychiatry, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro Gangnam-gu, Seoul, 06351, South Korea
| | - Sang Joon Son
- Department of Psychiatry, Ajou University School of Medicine, Suwon, South Korea
| | - Sung Yoon Kim
- Department of Psychiatry, Asan Medical Center, Ulsan University School of Medicine, Seoul, South Korea
| | - Jin Pyo Hong
- Department of Psychiatry, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro Gangnam-gu, Seoul, 06351, South Korea.
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Hwang J, Jeong JH, Yoon SJ, Park KW, Kim EJ, Yoon B, Jang JW, Kim HJ, Hong JY, Lee JM, Park H, Kang JH, Choi YH, Park G, Hong J, Byun MS, Yi D, Kim YK, Lee DY, Choi SH. Clinical and Biomarker Characteristics According to Clinical Spectrum of Alzheimer's Disease (AD) in the Validation Cohort of Korean Brain Aging Study for the Early Diagnosis and Prediction of AD. J Clin Med 2019; 8:jcm8030341. [PMID: 30862124 PMCID: PMC6463169 DOI: 10.3390/jcm8030341] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Revised: 03/04/2019] [Accepted: 03/07/2019] [Indexed: 01/09/2023] Open
Abstract
We aimed to present the study design of an independent validation cohort from the Korean Brain Aging Study for the Early Diagnosis and Prediction of Alzheimer's disease (AD) (KBASE-V) and to investigate the baseline characteristics of the participants according to the AD clinical spectrum. We recruited 71 cognitively normal (CN) participants, 96 with subjective cognitive decline (SCD), 72 with mild cognitive impairment (MCI), and 56 with AD dementia (ADD). The participants are followed for three years. The Consortium to Establish a Registry for AD scores was significantly different between all of the groups. The logical memory delayed recall scores were significantly different between all groups, except between the MCI and ADD groups. The Mini-Mental State Examination score, hippocampal volume, and cerebrospinal fluid (CSF) amyloid-β42 level were significant difference among the SCD, MCI, and ADD groups. The frequencies of participants with amyloid pathology according to PET or CSF studies were 8.9%, 25.6%, 48.3%, and 90.0% in the CN, SCD, MCI, and ADD groups, respectively. According to ATN classification, A+/T+/N+ or A+/T+/N- was observed in 0%, 15.5%, 31.0%, and 78.3% in the CN, SCD, MCI, and ADD groups, respectively. The KBASE-V showed a clear difference according to the AD clinical spectrum in neuropsychological tests and AD biomarkers.
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Affiliation(s)
- Jihye Hwang
- Department of Neurology, Keimyung University Dongsan Medical Center, Daegu 41931, Korea.
| | - Jee Hyang Jeong
- Department of Neurology, Ewha Womans University School of Medicine, Seoul 07985, Korea.
| | - Soo Jin Yoon
- Department of Neurology, Eulji University School of Medicine, Daejeon 35233, Korea.
| | - Kyung Won Park
- Department of Neurology, Dong-A Medical Center, Dong-A University College of Medicine, Busan 49201, Korea.
| | - Eun-Joo Kim
- Department of Neurology, Pusan National University Hospital, Pusan National University School of Medicine and Medical Research Institute, Busan 49241, Korea.
| | - Bora Yoon
- Department of Neurology, Konyang University College of Medicine, Daejeon 35365, Korea.
| | - Jae-Won Jang
- Department of Neurology, Kangwon National University Hospital, Kangwon National University College of Medicine, Chuncheon 24289, Korea.
| | - Hee Jin Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea.
| | - Jin Yong Hong
- Department of Neurology, Yonsei University Wonju College of Medicine, Wonju 26426, Korea.
| | - Jong-Min Lee
- Department of Biomedical Engineering, Hanyang University, Seoul 04763, Korea.
| | - Hyuntae Park
- Department of Health Care and Science, Dong-A University, Busan 49315, Korea.
| | - Ju-Hee Kang
- Department of Pharmacology, Inha University School of Medicine, Incheon 22212, Korea.
| | - Yong-Ho Choi
- Department of Biomedical Engineering, Hanyang University, Seoul 04763, Korea.
| | - Gilsoon Park
- Department of Biomedical Engineering, Hanyang University, Seoul 04763, Korea.
| | - Jinwoo Hong
- Department of Biomedical Engineering, Hanyang University, Seoul 04763, Korea.
| | - Min Soo Byun
- Institute of Human Behavioral Medicine, Medical Research Center Seoul National University, Seoul 03080, Korea.
| | - Dahyun Yi
- Institute of Human Behavioral Medicine, Medical Research Center Seoul National University, Seoul 03080, Korea.
| | - Yu Kyeong Kim
- Department of Nuclear Medicine, SMG-SNU Boramae Medical Center, Seoul 07061, Korea.
| | - Dong Young Lee
- Department of Neuropsychiatry, Seoul National University Hospital & Department of Seoul National University College of Medicine, Seoul 03080, Korea.
| | - Seong Hye Choi
- Department of Neurology, Inha University School of Medicine, Incheon 22332, Korea.
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Lee JY, Jeon B, Koh SB, Yoon WT, Lee HW, Kwon OD, Kim JW, Kim JM, Ma HI, Kim HT, Baik JS, Cho J. Behavioural and trait changes in parkinsonian patients with impulse control disorder after switching from dopamine agonist to levodopa therapy: results of REIN-PD trial. J Neurol Neurosurg Psychiatry 2019; 90:30-37. [PMID: 30361296 DOI: 10.1136/jnnp-2018-318942] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Revised: 09/06/2018] [Accepted: 09/23/2018] [Indexed: 11/03/2022]
Abstract
OBJECTIVE In this multicentre open-label trial, we compared behavioural and neuropsychiatric symptoms in Parkinson's disease (PD) patients with impulse control disorders (ICD) treated with dopamine agonists before and 12 weeks after substituting dopamine agonists with an equivalent dose of levodopa/carbidopa slow-release formulation. METHODS Baseline characteristics of 50 PD patients with ICD were compared with those of 60 medicated and 40 drug-naive PD control groups. Neuropsychiatric trait changes in the PD-ICD group were investigated 12 weeks after the intervention. ICD behaviours were assessed via modified Minnesota Impulsive Disorders Interview (mMIDI), whereas parkinsonian severity and neuropsychiatric characters were systematically assessed with the Unified PD Rating Scale (UPDRS) and a predefined neuropsychological assessment battery. RESULTS At baseline, ICD patients showed higher scores in the Neuropsychiatric Inventory and anxiety, anger and obsessive-compulsive traits compared with both PD control groups. In contrast, the three PD groups showed indifference in the impulsivity scales. At 12 weeks post intervention, ICD behaviours significantly improved (p<0.001, Δ modified MIDI score=‒5.27 ± 5.75) along with the UPDRS II daily activity scores (p=0.02, Δ=‒2.07 ± 4.53). Behavioural disinhibition tended to improve (p=0.06), although no significant changes were observed in the Neuropsychiatric Inventory and personality trait scores. Dopamine agonist withdrawal syndrome developed in 5.3% of the PD-ICD group. CONCLUSIONS This study provides class IV evidence suggesting that switching from dopamine agonists to levodopa/carbidopa slow-release formulations alleviated ICD behaviours in PD patients leading to improvement in daily activities whereas neuropsychiatric traits associated with ICD persisted after the 12-week therapy. TRIAL REGISTRATION NUMBER NCT01683253.
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Affiliation(s)
- Jee-Young Lee
- Department of Neurology, Seoul National University Boramae Hospital, Seoul, South Korea
| | - Beomseok Jeon
- Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Seong-Beom Koh
- Department of Neurology, Korea University Guro Hospital, Seoul, South Korea
| | - Won Tae Yoon
- Department of Neurology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Ho-Won Lee
- Department of Neurology, School of Medicine, Kyungpook National University, and Brain Science and Engineering Institute, Kyungpook National University, Daegu, South Korea
| | - Oh Dae Kwon
- Department of Neurology, Daegu Catholic University Medical Center, Daegu, South Korea
| | - Jae Woo Kim
- Department of Neurology, Dong-A University Hospital, Pusan, South Korea
| | - Jong-Min Kim
- Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea
| | - Hyeo-Il Ma
- Department of Neurology, Hallym University Hospital, Anyang, South Korea
| | - Hee-Tae Kim
- Department of Neurology, Hanyang University Medical Center, Seoul, South Korea
| | - Jong Sam Baik
- Department of Neurology, Inje University Sanggye Paik Hospital, Seoul, South Korea
| | - Jinwhan Cho
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, and Neuroscience Center, Samsung Medical Center, Seoul, South Korea
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Park S, Kim DK, Myung W, Yoo JH, Shin SJ, Na DL, Kim SY, Lee JH, Kim SY, Han SH, Choi SH, Shin J. Risk Factors of Behavioral and Psychological Symptoms in Patients with Alzheimer Disease: The Clinical Research of Dementia of South Korea Study. Korean J Fam Med 2018; 40:16-21. [PMID: 30369216 PMCID: PMC6351791 DOI: 10.4082/kjfm.17.0061] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 07/11/2017] [Indexed: 11/04/2022] Open
Abstract
Background Few studies have evaluated risk factors for behavioral and psychological symptoms of dementia at the initial assessment for Alzheimer disease in large patient samples. In this study, the factors influencing Alzheimer disease were examined using the Clinical Research of Dementia of South Korea data. Methods This cross-sectional study was conducted using data of 1,128 patients with Alzheimer disease. The behavioral and psychological symptoms of dementia were examined using the Korean version of the Neuropsychiatric Inventory. Demographic characteristics, health-related behavior, neuropsychological tests, comorbidities, blood test results, and caregiver characteristics were assessed. Median logistic regression analysis with adjustment for covariates was conducted. Results The behavioral and psychological symptoms of dementia were negatively associated with memory (P=0.022) and frontal/executive (P<0.001) function in the Seoul Neuropsychological Screening Battery-dementia, Barthel Index for Activities of Daily Living (P<0.001), Korean version of the Mini-Mental State Examination score (P=0.003), and caregiver age (P=0.005) after adjustment for confounding factors, and positively associated with the Seoul-Instrumental Activities of Daily Living score (P<0.001), Clinical Dementia Rating Sum of Box (P<0.001), Global Deterioration Scale score (P<0.001), abnormality of free T4 level (P<0.001), anemia (P<0.001), and family history of stroke (P=0.001). Patients with female caregivers exhibited more severe behavioral and psychological symptoms of dementia than those with male caregivers. Conclusion Behavioral and psychological symptoms of dementia in Alzheimer disease patients were associated with various risk factors including the inability to live independently and Alzheimer disease severity. These findings suggest that prevention and treatment strategies for the behavioral and psychological symptoms of dementia should be comprehensive.
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Affiliation(s)
- Sunyoung Park
- Department of Family Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Doh Kwan Kim
- Department of Psychiatry, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Woojae Myung
- Department of Psychiatry, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Jun Hyun Yoo
- Department of Family Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Su Jeong Shin
- Department of Family Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Duk L Na
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sang Yun Kim
- Department of Neurology, Seoul National University Bundang Hospital, Seoul, Korea
| | - Jae-Hong Lee
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seong Yoon Kim
- Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seol-Heui Han
- Department of Neurology, Konkuk University School of Medicine, Seoul, Korea
| | - Seong Hye Choi
- Department of Neurology, Inha University School of Medicine, Seoul, Korea
| | - Jinyoung Shin
- Department of Family Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
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Brain Perfusion Correlates of Apathy in Alzheimer's Disease. Dement Neurocogn Disord 2018; 17:50-56. [PMID: 30906392 PMCID: PMC6427971 DOI: 10.12779/dnd.2018.17.2.50] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 06/29/2018] [Indexed: 11/27/2022] Open
Abstract
Background and Purpose Apathy is one of the most common neuropsychiatric symptoms in patients with Alzheimer's disease (AD). It may have adverse impacts on the progression of AD. However, its neurobiological underpinnings remain unclear. The objective of this study was to investigate differences in regional cerebral blood flow (rCBF) between AD patients with apathy and those without apathy. Methods Sixty-six apathetic AD patients and 66 AD patients without apathy completed Neuropsychiatric Inventory (NPI) and underwent technetium-99m hexamethylpropylene amine oxime single-photon emission computed tomography (SPECT) scans. Voxel-wise differences in rCBF between the 2 groups were examined. Association between rCBF and levels of apathy in the apathetic group was also assessed. Results AD patients with apathy showed lower rCBF in the bilateral orbitofrontal cortex, left putamen, left nucleus accumbens, left thalamus, and bilateral insula than those without (all p<0.005). Mean perfusion across all significant clusters showed a negative linear correlation with NPI apathy score in AD patients with apathy (β=-0.25; p=0.04). Conclusions Hypoperfusion in the prefrontal, striatal, and insular areas may be neural correlates of apathy in AD patients.
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Kim T, Jeong H, Han JW, Kwak KP, Kim BJ, Kim SK, Kim JL, Kim TH, Ryu SH, Moon SW, Park JY, Park JH, Bae JN, Youn JC, Lee DY, Lee DW, Lee SB, Lee JJ, Jhoo JH, Lee J, Kim KW. Prevalence and Risk Factors of Abusive Behaviors in the Caregivers of People with Dementia in Korea. Psychiatry Investig 2018; 15:677-686. [PMID: 29969849 PMCID: PMC6056695 DOI: 10.30773/pi.2018.04.23] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2018] [Accepted: 04/23/2018] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE We investigated the prevalence and risk factors of physically abusive behaviors (PhAB) and psychologically abusive behaviors (PsAB) towards people with dementia (PWD) in family caregivers, and compared their prevalences between East Asian and Western countries. METHODS We estimated the prevalence and risk factors of PhAB and PsAB in 467 Korean pairs of community-dwelling PWD and their primary family caregivers. We evaluated abusive behaviors using the Modified Conflict Tactics Scale. In addition, we compared the prevalence of abusive behaviors between Asian and Western countries through a meta-analysis on 12 studies including the current one. RESULTS More than a half of the caregivers reported PsAB and about one out of seven caregivers admitted PhAB within past three months. PsAB and PhAB were slightly more prevalent in East Asian countries than in Western countries. Non-Alzheimer type and moderate to severe behavioral and psychological symptoms of dementia were associated with the risk of PhAB but not with the risk of PsAB. Severe care burden and low income were associated with the risk of PhAB and PsAB. CONCLUSION PhAB and PsAB were as prevalent in the family caregivers of PWD in Asian countries including Korea as in Western countries. Prevention strategies should be implemented according to the type of abusive behaviors.
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Affiliation(s)
- Taehyun Kim
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Hyeon Jeong
- Department of Psychiatry, Mirae Hospital, Gimje, Republic of Korea
| | - Ji Won Han
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Kyung Phil Kwak
- Department of Psychiatry, Dongguk Medical Center, Gyeongju, Republic of Korea
| | - Bong-Jo Kim
- Department of Psychiatry, Gyeongsang National University School of Medicine, Jinju, Republic of Korea
| | - Shin-Kyeom Kim
- Department of Neuropsychiatry, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
| | - Jeong Lan Kim
- Department of Psychiatry, Chungnam National University Hospital, Daejeon, Republic of Korea
| | - Tae Hui Kim
- Department of Psychiatry, Yonsei University Wonju Severance Christian Hospital, Wonju, Republic of Korea
| | - Seung-Ho Ryu
- Department of Psychiatry, School of Medicine, Konkuk University, Konkuk University Medical Center, Seoul, Republic of Korea
| | - Seok Woo Moon
- Department of Psychiatry, School of Medicine, Konkuk University, Konkuk University Chungju Hospital, Chungju, Republic of Korea
| | - Jae Young Park
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Joon Hyuk Park
- Department of Neuropsychiatry, Jeju National University Hospital, Jeju, Republic of Korea
| | - Jae Nam Bae
- Department of Psychiatry, Inha University Hospital, Incheon, Republic of Korea
| | - Jong Chul Youn
- Department of Neuropsychiatry, Kyunggi Provincial Hospital for the Elderly, Yongin, Republic of Korea
| | - Dong Young Lee
- Department of Neuropsychiatry, Seoul National University Hospital, Seoul, Republic of Korea.,Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Dong Woo Lee
- Department of Neuropsychiatry, Inje University Sanggye Paik Hospital, Seoul, Republic of Korea
| | - Seok Bum Lee
- Department of Psychiatry, Dankook University Hospital, Cheonan, Republic of Korea
| | - Jung Jae Lee
- Department of Psychiatry, Dankook University Hospital, Cheonan, Republic of Korea
| | - Jin Hyeong Jhoo
- Department of Psychiatry, Kangwon National University School of Medicine, Chuncheon, Republic of Korea
| | - Jungwon Lee
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Ki Woong Kim
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.,Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea.,Department of Brain and Cognitive Science, Seoul National University College of Natural Sciences, Seoul, Republic of Korea.,National Institute of Dementia, Seongnam, Republic of Korea
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The cholinergic contribution to the resting-state functional network in non-demented Parkinson's disease. Sci Rep 2018; 8:7683. [PMID: 29769626 PMCID: PMC5955917 DOI: 10.1038/s41598-018-26075-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 04/30/2018] [Indexed: 12/24/2022] Open
Abstract
The cholinergic system arising from the basal forebrain plays an important role in cognitive performance in Parkinson's disease (PD). Here, we analyzed cholinergic status-dependent cortical and subcortical resting-state functional connectivity in PD. A total of 61 drug-naïve PD patients were divided into tertiles based on normalized substantia innominata (SI) volumes. We compared the resting-state network from seed region of interest in the caudate, posterior cingulate cortex (PCC), and SI between the lowest (PD-L) and highest tertile (PD-H) groups. Correlation analysis of the functional networks was also performed in all subjects. The functional network analysis showed that PD-L subjects displayed decreased striato-cortical functional connectivity compared with PD-H subjects. Selecting the PCC as a seed, the PD-L patients displayed decreased functional connectivity compared to PD-H patients. Meanwhile, PD-L subjects had significantly increased cortical functional connectivity with the SI compared with PD-H subjects. Correlation analysis revealed that SI volume had a positive correlation with functional connectivity from the right caudate and PCC. The present study demonstrated that PD patients exhibited unique functional connectivity from the caudate and the PCC that may be closely associated with cholinergic status, suggesting an important role for the cholinergic system in PD-associated cognition.
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Hong YJ, Choi SH, Jeong JH, Park KW, Na HR. Effectiveness of Anti-Dementia Drugs in Extremely Severe Alzheimer’s Disease: A 12-Week, Multicenter, Randomized, Single-Blind Study. J Alzheimers Dis 2018; 63:1035-1044. [DOI: 10.3233/jad-180159] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- Yun Jeong Hong
- Biomedical Research Institute, Pusan National University Hospital, Pusan, South Korea
| | - Seong Hye Choi
- Department of Neurology, Inha University School of Medicine, Incheon, South Korea
| | - Jee Hyang Jeong
- Department of Neurology, Ewha Womans University Mokdong Hospital, Ewha Womans University School of Medicine, Seoul, South Korea
| | - Kyung Won Park
- Department of Neurology, Cognitive Disorders and Dementia Center, Dong-A University College of Medicine and Institute of Convergence Bio-Health, Pusan, South Korea
| | - Hae Ri Na
- Department of Neurology, Bobath Memorial Hospital, Seongnam, South Korea
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Lee J, Sohn BK, Lee H, Seong SJ, Park S, Lee JY. Attachment style and filial obligation in the burden of caregivers of dementia patients. Arch Gerontol Geriatr 2017; 75:104-111. [PMID: 29241090 DOI: 10.1016/j.archger.2017.12.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Revised: 11/29/2017] [Accepted: 12/01/2017] [Indexed: 10/18/2022]
Abstract
Insecure attachment styles have been known to predict greater burden in caregivers of dementia patients. However, it has not been tested how filial obligation, which refers to one's sense of duty on helping elderly parents and is especially pronounced in Asian cultures, is involved in that relationship. We sought to identify whether the association between attachment style and caregiver burden differs according to the degree of filial obligation in caregivers of dementia patients. To assess filial obligation in Korean participants, a Korean filial obligation measure was developed. Ninety-eight Korean female caregivers of dementia patients reported their attachment style, filial obligation, burden, and patient behavioral symptoms. Patients' cognitive abilities, daily activity levels, and global dementia severities were obtained from hospital records. When adjusting for caregiver and patient characteristics, greater attachment anxiety predicted higher burden, corroborating literature findings. However, the association of attachment avoidance with burden was contingent on filial obligation: When obligation was high, greater avoidance associated with lower burden, which contrasts with previous negative implications of attachment insecurity. This implies a buffering role of attachment avoidance among those highly obligated. In addition, obligation positively predicted burden among those low in avoidance. This study is the first one to investigate and find conditional associations between attachment style, filial obligation, and caregiver burden. Given that filial obligation tends to be higher in caregivers of Eastern countries, this study provides quantitative evidence that the caregiving process may be different for them.
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Affiliation(s)
- Juwon Lee
- School of Psychology, Faculty of Health, Deakin University, Burwood, VIC, Australia
| | - Bo Kyung Sohn
- Department of Psychiatry, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Hyunjoo Lee
- Department of Social Welfare, Daegu University, Gyeongsan, Republic of Korea
| | - Su Jeong Seong
- Department of Psychiatry, Hallym University Kangdong Sacred Heart Hospital, Seoul, Republic of Korea
| | - Soowon Park
- Department of Education, Sejong University, Seoul, Republic of Korea
| | - Jun-Young Lee
- Department of Psychiatry and Behavioral Science, Seoul National University College of Medicine & SMG-SNU Boramae Medical Center, Seoul, Republic of Korea.
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Hypertension and Neuropsychiatric Symptoms in Patients with Drug-Naïve Alzheimer's Disease. Dement Neurocogn Disord 2017; 16:78-82. [PMID: 30906375 PMCID: PMC6427990 DOI: 10.12779/dnd.2017.16.3.78] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Revised: 09/10/2017] [Accepted: 09/10/2017] [Indexed: 11/30/2022] Open
Abstract
Background and Purpose Neuropsychiatric symptoms (NPS) such as anxiety, depression, and delusions affect up to 90% of all patients with Alzheimer's disease (AD). NPS is associated with significant caregiver burden and patient distress. Given the severe burden of NPS in AD, it is critical to know potential modifiable risk factors of NPS in AD. This study explores the association between hypertension and NPS in patients with drug-naïve AD. Methods We reviewed medical records of 149 patients with AD with (n=80) and without (n=69) hypertension. NPS were assessed using the Korean version of Neuropsychiatric Inventory (K-NPI). Affective, psychotic, and behavior symptom clusters were assessed separately. Results The total score of K-NPI was not significantly different between patients with AD with and without hypertension. Among K-NPI domains, scores of depression/dysphoria (p=0.045), anxiety (p=0.022), and apathy/indifference (p=0.037) were significantly higher in patients with AD with hypertension. Systolic blood pressure (BP) was associated with higher total K-NPI and affective symptom cluster scores. Diastolic BP was associated with affective symptom cluster scores. Conclusions Results suggest that hypertension increases risk of specific NPS in patients with AD. Among NPS, hypertension was associated with affective symptom cluster.
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Lee Y, Ho Choi Y, Lee JJ, Lee HS, Sohn YH, Lee JM, Lee PH. Microstructural white matter alterations in patients with drug induced parkinsonism. Hum Brain Mapp 2017; 38:6043-6052. [PMID: 28901627 DOI: 10.1002/hbm.23809] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 08/24/2017] [Accepted: 09/01/2017] [Indexed: 11/10/2022] Open
Abstract
Drug-induced parkinsonism (DIP) is the second most common etiology of parkinsonism. And yet, there is little information on structural imaging in DIP to elucidate the accurate underlying pathomechanisms. To investigate microstructural white matter (WM) in patients with DIP using diffusion tensor image and to determine its relationship to severity of parkinsonian motor symptoms and cognitive function. A total of 42 patients with DIP, 65 with Parkinson's disease, and 33 control subjects were recruited from a movement disorders outpatient clinic. We performed comparative analysis of fractional anisotropy (FA) and mean diffusivity (MD) values among groups using tract-based spatial statistics. Correlation analysis between WM integrity and parkinsonian motor symptoms and cognitive performance was also performed in DIP patients using voxel-wise statistical analysis. DIP patients had significantly lower FA and higher MD values over widespread WM areas than control subjects. The patients with DIP had poor cognitive performance relative to control subjects, which correlated well with WM properties. Additionally, the parkinsonian motor symptoms were negatively correlated with FA values. In contrast, exposure time to the offending drugs prior to the development of parkinsonism or duration of parkinsonism showed no significant association with FA or MD values. The present study demonstrates that disruption of the WM microstructure is extensive in patients with DIP, and it is correlated with clinical parameters of parkinsonism and cognitive performance. This suggests that DIP may be reflective of underlying abnormality of microstructural WM. Hum Brain Mapp 38:6043-6052, 2017. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Yoonju Lee
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Yong Ho Choi
- Department of Biomedical Engineering, Hanyang University, Seoul, South Korea
| | - Jae Jung Lee
- Department of Neurology, Inje University College of Medicine, Ilsan Paik Hospital, Goyang, South Korea
| | - Hye Sun Lee
- Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, South Korea
| | - Young H Sohn
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Jong-Min Lee
- Department of Biomedical Engineering, Hanyang University, Seoul, South Korea
| | - Phil Hyu Lee
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea.,Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, South Korea
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Yoon B, Shim YS, Hong YJ, Choi SH, Park HK, Park SA, Jeong JH, Yoon SJ, Yang DW. Anosognosia and Its Relation to Psychiatric Symptoms in Early-Onset Alzheimer Disease. J Geriatr Psychiatry Neurol 2017; 30:170-177. [PMID: 28421896 DOI: 10.1177/0891988717700508] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND We investigated differences in the prevalence of anosognosia and neuropsychiatric symptoms (NPSs) characteristics according to disease severity in patients with early-onset Alzheimer disease (EOAD). METHODS We recruited 616 patients with EOAD. We subdivided participants into 2 groups based on the presence or absence of anosognosia and then again by Clinical Dementia Rating (CDR) scale. We compared the differences in the Neuropsychiatric Inventory (NPI) scores according to anosognosia and disease severity. RESULTS The percentage of patients with anosognosia in each CDR group steadily increased as the CDR rating increased (CDR 0.5 8.6% vs CDR 1 13.6% vs CDR 2 26.2%). The NPI total score was significantly higher in patients with anosognosia in the CDR 0.5 and 1 groups; by contrast, it had no association in the CDR 2 group. Frontal lobe functions were associated with anosognosia only in the CDR 0.5 and 1 groups. After stratification by CDR, in the CDR 0.5 group, the prevalence of agitation ( P = .040) and appetite ( P = .013) was significantly higher in patients with anosognosia. In the CDR 1 group, patients with anosognosia had a significantly higher prevalence of delusions ( P = .032), hallucinations ( P = .048), and sleep disturbances ( P = .047). In the CDR 2 group, we found no statistical difference in the frequency of symptoms between patients with and without anosognosia. CONCLUSION These results confirm that the prevalence of anosognosia as well as the individual NPS and cognitive functions associated with it differ according to EOAD severity.
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Affiliation(s)
- Bora Yoon
- 1 Department of Neurology, Konyang University Hospital, College of Medicine, Konyang University, Daejeon, Republic of Korea
| | - Yong S Shim
- 2 Department of Neurology, Bucheon St Mary's Hospital, College of Medicine, The Catholic University of Korea, Bucheon, Republic of Korea
| | - Yun Jeong Hong
- 3 Department of Neurology, Dong-A University College of Medicine, Busan, Republic of Korea
| | - Seong Hye Choi
- 4 Department of Neurology, Inha University School of Medicine, Incheon, Republic of Korea
| | - Hee Kyung Park
- 5 Department of Neurology, Inje University Ilsan Paik Hospital, Goyang, Republic of Korea
| | - Sun Ah Park
- 6 Department of Neurology, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
| | - Jee Hyang Jeong
- 7 Department of Neurology, Ewha Womans University Mokdong Hospital, Ewha Womans University School of Medicine, Seoul, Republic of Korea
| | - Soo Jin Yoon
- 8 Department of Neurology, Eulji University Hospital, Eulji University School of Medicine, Daejeon, Republic of Korea
| | - Dong-Won Yang
- 9 Department of Neurology, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Cerebral Perfusion Changes after Acetyl-L-Carnitine Treatment in Early Alzheimer's Disease Using Single Photon Emission Computed Tomography. Dement Neurocogn Disord 2017; 16:26-31. [PMID: 30906367 PMCID: PMC6427992 DOI: 10.12779/dnd.2017.16.1.26] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 03/24/2017] [Accepted: 03/24/2017] [Indexed: 12/05/2022] Open
Abstract
Background and Purpose Although acetyl-L-carnitine (ALC) treatment may have beneficial effects on Alzheimer's disease (AD), its underlying neural correlates remain unclear. The purpose of this study was to investigate cerebral perfusion changes after ALC treatment in AD patients using technetium-99m hexamethylpropylene amine oxime single photon emission computed tomography (SPECT). Methods A total of 18 patients with early AD were prospectively recruited and treated with ALC at 1.5 g/day for 1.4±0.3 years. At baseline and follow-up, brain SPECT, Mini-Mental State Examination (MMSE), Clinical Dementia Rating (CDR), Global Deterioration Scale (GDS), and Neuropsychiatric Inventory (NPI) were used to assess participants. After ALC administration, changes in brain perfusion, severity of dementia, cognitive performance, and neuropsychiatric disturbances were examined. Results After ALC administration, changes in scores of MMSE, CDR, GDS, and NPI were not statistically significant (p>0.05). Voxel-wise whole-brain image analysis revealed that perfusion was significantly (p<0.001) increased in the right precuneus whereas perfusion was reduced in the left inferior temporal gyrus (p<0.001), the right middle frontal gyrus (p<0.001), and the right insular cortex (p=0.001) at follow-up. Conclusions Although previous studies have suggested that AD patients generally demonstrate progressive deterioration in brain perfusion and clinical symptoms, this study reveals that the perfusion of the precuneus is increased in AD patients after ALC administration and their cognitive and neuropsychiatric symptoms are not aggravated. Further studies are warranted to determine the potential association between perfusion increase in the precuneus and clinical symptoms after ALC treatment in AD patients.
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